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Findings
- Accumulation of air in the orbit and/or eyelids
- Typically after medial orbital wall fracture followed by nose blowing
- Swelling of the eyelids
- Palpable crepitation
- Proptosis, visual impairment, double vision (often when looking upward), increased intraocular pressure, lagophthalmos
- Warning signs: Pain, visual impairment, relative afferent pupillary defect (RAPD), increased intraocular pressure, restricted motility
Work-up
Treatment
- Mostly observational as it is self-limiting
- Oral antibiotics (e.g., Co-Amoxicillin 625mg 3x/day for 7-10 days)
- Decongestant nasal spray (e.g., Otrivin 0.1% 2x/day)
- Local cooling, elevated upper body, avoid nose blowing!
- If suspected orbital compartment syndrome (Stages (II), III-IV):
Stages
- I: radiological, no clinical sign
- conservative
- II: globe dystopia / proptosis, displacement of the globe horizontally or vertically
- conservative, except if significant discomfort
- III: Loss of vision due to optic nerve compression, IOP elevated
- immediate decompression
- IV: Central retinal artery occlusion
- immediate decompression
Sources
- Wikipedia – Orbital emphysema
- Lin, Che-Yu et al. “Needle decompression in a patient with vision-threatening orbital emphysema.” Taiwan journal of ophthalmology vol. 6,2 (2016): 93-95. doi:10.1016/j.tjo.2015.02.003
- Shameer A, Pushker N, Lokdarshi G, Basheer S, Bajaj MS. Emergency Decompression of Orbital Emphysema with Elevated Intraorbital Pressure. J Emerg Med. 2017 Sep;53(3):405-407. doi: 10.1016/j.jemermed.2016.10.021. PMID: 28992871.
- Hunts JH, Patrinely JR, Holds JB, Anderson RL. Orbital emphysema. Staging and acute management. Ophthalmology. 1994 May;101(5):960-6. PMID: 8190488.