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Facial fractures and their historical link to potential blindness have been well-documented, often attributed to optic canal injuries or retinal vascular occlusion. This dire consequence can result from both direct and indirect ocular trauma, including retrobulbar hemorrhage. Traumatic orbital compression can manifest in various forms, such as hematomas, fractured bone fragments, and emphysema, all posing a significant threat to vision, necessitating immediate intervention. In this study, 9 clinical cases of traumatic orbital compression are presented, each characterized by distinct etiologies. The study delves into traumatic orbital compressive syndromes, underscoring the critical imperative of early recognition and treatment to prevent vision loss. Orbital compression, whether from edema, hematoma, or emphysema, collectively culminates in elevated intraorbital pressure and the potential for optic nerve ischemia. Through the presentation of these 9 clinical cases, the article emphasizes the pressing need for timely intervention in addressing orbital compressive syndromes to avert vision loss. Various surgical techniques are elucidated, highlighting the pivotal role of expeditious medical intervention. This article offers invaluable insights into the diagnosis, management, and outcomes of traumatic orbital compressive syndromes., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

A 19-year-old with blunt trauma and repeated nose blowing presented with orbital emphysema and orbital compartment syndrome. Orbital emphysema is the abnormal presence of air within the orbit, typically secondary to trauma. Most cases will resolve with observation alone, however orbital compartment syndrome is a feared complication that necessitates urgent decompression. A superior fornix, trans-conjunctival approach was safely utilized to decompress the orbit while avoiding unwanted complications. Various decompression techniques have previously been described, most of which describe trans-palpebral approaches. The key safety benefit to the trans-conjunctival approach is direct visualization of the needle tip adjacent to the superior fornix, therefore posterior to the equator of the globe. With the needle positioned parallel to the curvature of the globe at the equator, the posterior sclera surface curves away from the tip, rendering it difficult to pierce the globe. In addition, the needle needs to be advanced only 3-4 millimeters and traverses only the conjunctiva and Tenon's to enter the central surgical space - the most direct route to the air pocket. The trans-conjunctival approach lowers the risk of damage to eyelid neurovascular structures and is less painful.

Abstract: Repeated bouts of nose blowing can at times lead to orbital emphysema due to stress fracture in the medial or the inferior wall of the orbit. Very rarely, this can result from paranasal sinus osteoma rendering the orbital wall weak. We report only the fifth case of literature to have such an association. Also, we managed our case non-surgically, as against the previous reports treated surgically. In discussion, we highlight the nuances related to principles of management, including the role of computed tomography, and surgical intervention., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 by Mutaz B. Habal, MD.)

Significance: Orbital emphysema is a well-documented condition where air enters the orbital soft tissue typically because of direct or indirect trauma; however, atraumatic cases can be encountered. The following is a novel case report of acute unilateral atraumatic orbital emphysema 24 hours after bronchoscopy with endobronchial biopsy., Purpose: To the best of the authors' knowledge, this is the first known case report of atraumatic orbital emphysema as a postprocedure complication of bronchoscopy with endobronchial biopsy in the literature., Case Report: A 74-year-old man presented with painless swelling of the left upper and lower eyelids upon awakening. The patient had a history of bronchoscopy and endobronchial biopsy with conscious sedation for a right upper lobe lung mass 24 hours before the visit. Slit-lamp examination revealed air entrapment in the left upper and lower lids with enlarged subconjunctival air pockets of the left eye. Head and maxillofacial computed tomography without contrast revealed extensive emphysema tracking and dissecting along the subcutaneous and deep soft tissue spaces of the neck and face that was more pronounced along the left side. The patient was admitted for overnight observation and prescribed a prophylactic oral course of 250 mg of azithromycin daily for 2 days by the attending hospitalist. The subsequent follow-up visit 3 days later revealed complete resolution of signs and symptoms., Conclusions: This case report demonstrates the importance of considering orbital emphysema in patients with a history of recent bronchoscopy with endobronchial biopsy. Clinicians should be aware of this potential complication and refer for appropriate testing and comanagement., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2021 American Academy of Optometry.)

Facial and orbital emphysema without any trauma is an uncommon condition that might occur after nose blowing or sneezing efforts. It is usually self-limited and resolves spontaneously within two weeks. Surgical treatment is only reserved in case of complications such as neurological deficiencies or infection of the ocular globe. We report the case of a 42 year-old patient presenting a right spontaneous facial and orbital emphysema following nose blowing, treated by conservative measures, with a systematic review of the literature., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Orbital emphysema is an abnormal presence of air in the orbit. It usually arises after blunt trauma or periorbital surgery. When it occurs after dacryocystorhinostomy, usually it is reported as a benign condition. We present a case of a severe orbital emphysema secondary to transcanalicular diode laser-assisted dacryocystorhinostomy. The day after the surgery, the examination revealed crepitant periorbital swelling, general restriction of extraocular motility, visual loss and intraocular pressure of more than 70 mmHg. A computed tomography showed a massive orbital emphysema. An emergency decompression, using a 25-gauge needle attached to an empty syringe lacking a plunger was performed, achieving a quick decrease of intraocular pressure and pain and swelling improvement. Then, in this case, orbital decompression by passive airflow using a needle without a plunger was an effective treatment method to resolve a serious orbital emphysema after transcanalicular laser-assisted dacryocystorhinostomy.

Purpose: To describe preoperative, intraoperative, and postoperative characteristics, imaging findings, and clinical evolution of patients who developed orbital emphysema after vitreoretinal surgery., Design: Retrospective, descriptive, observational case series., Participants: Patients with orbital emphysema after vitreoretinal surgery who were diagnosed and treated between January 2006 and October 2018 at a single ophthalmology referral center., Methods: Medical records and orbital computed tomography images were reviewed and analyzed. A minimum follow-up of 3 months was required., Main Outcome Measures: Final best-corrected visual acuity (BCVA)., Results: This study included 16 patients with a mean age of 47.9 ± 14.7 years, 50% were women, and 25% had a history of previous ocular trauma. A diagnosis of rhegmatogenous retinal detachment was established in 75% of patients. Twenty-five percent of patients underwent pars plana vitrectomy (PPV), 50% underwent encircling scleral buckling plus PPV, 18.8% underwent repeat PPV, and 6.2% underwent scleral buckling plus repeat PPV. Additionally, 62.5% received silicone oil endotamponade. The median time between vitreoretinal surgery and orbital emphysema was 8 days (interquartile range [IQR] 5-15 days). Mean proptosis was 6.7 ± 4.6 mm. Orbital cellulitis was considered as a differential diagnosis in 31.2% of patients, and tomographic evidence of fracture was observed in 25% of patients. Treatment with compressive patching was prescribed for 87.5% of patients, transpalpebral drainage was prescribed for 75% of patients, hyperbaric oxygen therapy was prescribed for 43.8% of patients, and surgical management was prescribed for 31.2% of patients. The comparison between BCVA before vitreoretinal surgery (median, 1.8 logarithm of the minimum angle of resolution [logMAR]; IQR, 1.33-2.3 logMAR) and at the last follow-up (median, 2.3 logMAR; IQR, 1.42-2.8 logMAR) was not statistically significant (P = 0.125, Wilcoxon matched-pairs signed-rank test). No association was found between surgeon experience and lower final BCVA (P = 0.604, Fisher exact test); however, development of ocular hypertension was associated with worse final BCVA (P = 0.0101; relative risk, 7; 95% confidence interval, 1.01-44.63)., Conclusions: Although orbital emphysema constitutes a very unusual complication of vitreoretinal surgery, it is important to identify this condition promptly and treat patients efficiently to avoid potential vision loss., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Periorbital emphysema is a well-known but very rare complication after rhinoplasty. Here, we present a case of periorbital emphysema presenting with diplopia and eyeball deviation after rhinoplasty. All symptoms disappeared spontaneously within days, without any complications.

Purpose: The objective of this study was to report a case of persistent and likely self-induced orbital emphysema (OE) following functional endoscopic sinus surgery with dislodgement of a previously placed orbital floor implant and to review the literature surrounding etiologies, pathophysiology, and management of OE., Methods: Case report and review of the literature., Results and Discussion: While blunt trauma resulting in disruption of the medial orbital wall is the most common cause of OE, there are an additional 25 underlying etiologies reported in the current literature. Pathophysiology of OE is somewhat dependent on underlying etiology but often involves a 1-way ball valve mechanism such that air may enter the orbit but not exit. When sufficient air enters the orbit, complications secondary to increased intraorbital pressure, including central retinal artery occlusion and compressive optic neuropathy, can occur. Mild cases of OE are typically observed, with most resolving within 7 to 10 days. Moderate cases are often managed by lateral canthotomy and cantholysis with possible needle decompression. Severe cases may require urgent surgical decompression. While the majority of cases of OE are benign and self-limited, there have been 4 reports in the literature documenting significant vision loss., Conclusions: Although there is often a history of trauma in patients presenting with OE, many other underlying etiologies have been reported with several cases occurring spontaneously. As such, OE should be included on the differential for a patient presenting with a sudden onset of orbital signs.

Orbital emphysema can be a rare and severe postoperative complication. Fast and critical diagnosis is essential to avoid permanent visual loss to the patient. Therefore, a case of a male patient victim of a motorcycle accident with a postoperative complication of orbital emphysema has been presented. The immediate diagnosis and treatment of the orbital emphysema revealed to be the main success factors for the resolution of this complication.

Orbital compartment syndrome typically occurs due to trauma or burns. Here we discuss a case of spontaneous lamina papyracea dehiscence associated with transient orbital compartment syndrome. A previously healthy woman presented to the Emergency Department complaining of unilateral eye pain after nose blowing. The patient did not have any pupillary or extra-ocular movement abnormalities; however, she did have mildly decreased visual acuity in the affected eye. Intraocular pressure was found to be elevated and a subsequent CT scan showed orbital emphysema with spontaneous dehiscence of the lamina papyracea. The intraocular pressure decreased within hours, and ultimately, she required no intervention. [Full article available at http://rimed.org/rimedicaljournal-2018-02.asp].

Three patients with a history of previous pars-plana vitrectomy, 2 of them with perfluoropropane, and 1 with sulfur hexafluoride used, experienced eyelid swelling and pain after travelling to a higher altitude city. Gas was found in the orbit and periocular tissues, causing orbital compartment syndrome in 2 of the patients. The gas persisted on these patients despite surgical intervention, so hyperbaric oxygen therapy was advised. One patient refused, the other patient responded well to this therapy and the gas disappeared. The patient without an orbital compartment syndrome made a full recovery without needing medical or surgical intervention.

The case example presented shows that an orbital emphysema with exophthalmos can occur as a rare complication of a transconjunctival pars plana vitrectomy. Close monitoring of the patient symptoms, ocular motility, intraocular pressure and the fundus showed no evidence of compressive optic neuropathy or perfusion abnormalities through orbital vessels. The exophthalmos resolved spontaneously within a few days without any consequences.

An 18-year-old female athlete with a history of multiple traumatic concussions presented with complaints of recurrent bouts of right periorbital swelling that arose with Valsalva maneuvers such as nose-blowing or sneezing. The swelling resolved over hours to days. A CT scan of the sinuses revealed an osteoma originating from the right ethmoid roof involving the frontal recess and projecting into the orbit. She underwent excision of the osteoma via endoscopic transnasal and transcaruncular anterior orbitotomy approaches without complication.

This is a case description of a male patient found to have orbital and intracranial emphysema, specifically with air in his cavernous sinuses bilaterally following penetrating trauma to the medial orbit from a goat's horn. There were no orbital or skull base fractures. Although the presence of traumatic intracranial emphysema is not uncommon, it is typically the result of direct communication of the cranial vault with the paranasal sinuses in the setting of associated fracture or, alternatively, from direct penetration and inoculation. We present a rare case of orbital emphysema with traumatic intracranial emphysema without these previously described associations and postulate a mech``anism behind its development.

A 7 yr old, neutered male Japanese chin presented to the Cummings School of Veterinary Medicine at Tufts University (CSVMTU) for evaluation of chronic unilateral orbital swelling that worsened following an episode of respiratory distress. The left eye had been enucleated 5 yr previously. Intermittent mild-to-moderate left orbital swelling had been noted by the owner since the initial surgery. Examination demonstrated a moderate-to-severe, soft, fluctuant swelling involving the left orbit with erythema of the overlying skin. Crepitus was noted over the occipital tuberosity. Computed tomography revealed a large volume of gas involving the left orbit. The gas extended caudally within the subcutaneous tissues to both hemimandibles, dorsal to the cranium, and partially surrounded the cranial neck. The presence of a mucosa-lined, air-filled space with a patent nasolacrimal duct was noted on orbital exploration. The lining was removed and the duct closed. Histopathology confirmed the presence of an epithelial lining. No recurrence of the swelling was observed on examination 8 wk after surgery. This is the first report documenting acute worsening of orbital swelling following an episode of respiratory distress. This case highlights the importance of addressing the nasolacrimal duct while performing an enculeation in a brachycephalic dog.

Although orbital emphysema is a recognized complication of orbital fractures involving any of the paranasal sinuses, it may develop without any fracture. A 23-year-old man presented with sudden left periorbital swelling during weight lifting in a fitness facility. On the left side, there was periorbital swelling with crepitus in palpation of subcutaneous tissue and conjunctival congestion. Computed tomography showed no fractures in the orbit. The patient was hospitalized. He was treated with empiric antibiotics and non-steroidal antiinflammatory drugs. In three days, the swelling and crepitus had almost disappeared. Seven days later, orbital emphysema had completely resolved.

Case Report: We report the case of a 2 year-old child with orbital emphysema secondary to a compressed-air gun shot in the malar region, with no evidence of orbital wall fracture. Conservative treatment was applied, and no complications were observed., Discussion: Orbital emphysema in the absence of an orbital wall fracture is a rare situation. Orbital emphysema is usually seen in facial trauma associated with damage to the adjacent paranasal sinuses or facial bones. To our knowledge there have been very few reports of orbital emphysema caused by a compressed-air injury., (Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.)

The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described. Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226). In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

A 36-year-old man with Crouzon syndrome was referred post-operatively with unilateral painful limitation of eye movements and proptosis following removal of bilateral malar and orbital rim implants. Further investigation revealed right inferior orbital emphysema, caused by the intra-operative entrance of hydrogen peroxide through a suspected perforation of the orbital septum. The symptoms settled with conservative management.

Orbital emphysema is a benign self-limiting condition. It can occur directly (as a result of trauma to the face) or indirectly (secondary to a blowout fracture). We report a case of orbital emphysema in a 38-year-old man who presented with ecchymosis of the right eye, pressure within the right orbit, and periorbital swelling following a protracted episode of vigorous sneezing. The diagnosis was confirmed by computed tomography. Systemic antibiotics were given, and the patient was cautioned to avoid blowing his nose. His signs and symptoms resolved within 1 week.

In this paper, we are presenting the first case of accidental orbital emphysema as a complication of rhinoplasty operation, published in the literature. We have reviewed the literature for orbital-periorbital complications due to rhinoplasty operations and discussed the treatment choices for orbital emphysema.

We report a case who developed unilateral orbital emphysema after sneezing in a 30-year-old man presented with left crepitant eyelid swelling and progressive ptosis. Sneezing may cause orbital emphysema in cases with a history of minor periorbital trauma. While periodical followup without any medication is considered satisfactory, needle decompression may provide early cure.

Clinically significant periorbital emphysema is an unusual complication of functional endoscopic sinus surgery (FESS). In most instances, it resolves spontaneously without any serious sequelae. Rarely, it can progress rapidly and become severe enough to cause irreversible blindness. We present and discuss the management of 2 cases of periorbital emphysema after FESS.

Orbital emphysema is the abnormal presence of air in the orbit. Occurrence in the absence of orbital fracture is rare. We report a case of a 40-year-old female presenting unilateral orbital emphysema after vigorous nose blowing. She developed sudden visual loss as a result of elevated intraocular pressure and urgent treatment was required. She underwent an orbital decompression, performed using a 24-gauge needle puncture adjacent to the supraorbital notch. After treatment, she reported considerable decrease of symptoms.

Osteoma is the most common neoplasm of the paranasal sinuses usually involving the frontal sinus. Osteomas are benign, but can cause serious intracranial or orbital complications. The authors report a frontal sinus osteoma with orbital emphysema in a 16-year-old boy with a history of right-eye swelling after nose blowing. CT showed a right frontal sinus bony mass. Intraoperatively, strands of mucosa extending from the frontal sinus around the periphery of the mass in the right orbit were seen. The mass was excised and the orbital roof repaired. Histopathology was consistent with osteoma. The osteoma facilitated entrance of sinus air in the orbit, resulting in recurrent orbital emphysema with nose blowing. There was no recurrence of orbital emphysema after resection.

Introduction: Orbital emphysema is a recognised complication of fractures of the orbit and only rarely poses a threat to vision., Patients and Methods: We present three patients with threatened vision secondary to orbital emphysema that required an immediate surgical decompression., Results: Visual function was preserved in all three patients., Conclusion: Clinical awareness of pneumo-orbitism is vital as immediate orbital decompression may be necessary to preserve visual function.

Orbital emphysema following conjunctival tear in the absence of orbital wall fracture, caused by air under pressure is rare. Usually orbital emphysema is seen in facial trauma associated with damage to the adjacent paranasal sinuses or facial bones. To the best of our knowledge, there have been only eight reports of orbital emphysema following use of compressed air during industrial work. The air under pressure is pushed through the subconjunctival space into the subcutaneous and retrobulbar spaces. We present here a rare cause of orbital emphysema in a young man working with compressed air gun. Although the emphysema was severe, there were no orbital bone fracture and the visual recovery of the patient was complete without attendant complications.

Orbital emphysema is a well-recognized complication of fractures involving the orbit. Commonly, it occurs when high pressure develops in nasal cavity as during nose blowing, coughing or Valsalva's maneuver and usually occurs in the subcutaneous tissues. We report the case of a young breath-hold diver who developed spontaneous, non compressive orbital emphysema during underwater fishing, with a maximal depth of 25-30 meters in the Sardinian sea. He was otherwise healthy, without previous cranio-facial trauma and nasosinusal diseases or surgery were not present in the history. When he was referred to our attention the patient presented right eyelid ptosis but diplopia and vision impairment were absent. Computer tomography scans showed subcutaneous air in the right upper eyelid and around the eyeball, particularly near the orbit's roof but optic nerve area, intraconal, was free of air. A dehiscence in lamina papyracea was evident. In our opinion, this has been the point of air entry into the orbit. A supportive therapy was advised and two weeks later the emphysema was recovered completely and the subject was symptoms free. The literature has been revised and to our knowledge no previous cases of barotraumatic orbital emphysema, in a breath-hold diver, are referred.

A 41-year-old woman underwent endoscopic sinus surgery and 24 hours later, she developed acute orbital emphysema with marked vision loss. CT showed disruption of the inferior aspect of the medial wall of the orbit with fat herniation. She was immediately treated with the application of bedside palmar pressure to the globe with complete return of her vision without the need for a needle aspiration or orbital decompression. Weeks later, the patient experienced 2 more episodes of transient monocular visual loss that were again successfully treated with the same palmar pressure. Bedside digital decompression may be a potentially helpful method of restoring vision in cases of orbital emphysema with acute vision loss. We advise attempting this simple bedside procedure before committing the patient to a more invasive needle aspiration or surgical decompressive procedure.