Delayed orbital emphysema as the manifestation of isolated medial orbital wall fracture

Abstract

34-year-old male plumber presented to the Emerency Department (ED) for sudden onset of painful eft infraorbital swelling when he was blowing his ose. Two days before presentation, the patient struck is left eye on a pipe protruding from a wall when bruptly turning his head to the left. Due to the hollow tructure of the pipe, the injury was seemingly limited o an abrasion and contusion in the periorbital area ith sparing of the globe. After the injury, he visited n ophthalmologic clinic and treatment with topical edications was prescribed. On physical examination, there was superficial brasion over the left infraorbital region. The area ppeared swollen with palpable crepitus. Visual acuity as 20/20 in both eyes. Extraocular movements and unduscopic examinations of both eyes were normal. n orbital computed tomography (CT) scan showed bnormal air accumulated in the infraorbital area (Figre 1). A small medial orbital wall (lamina papyracea) racture was also noted with protrusion of soft tissue nto the ethmoid sinus (Figure 2). Oral antibiotic and nalgesic agents were prescribed and he was advised