Emphysema of the Eyelid and Orbit after a Gwen Slap-A Rare Case Report

Abstract

The causes of orbital emphysema are very abound. The most common cause is blunt trauma; most of them lead to fractures of the paranasal sinuses. Clinical findings of orbital emphysema may include periorbital redness and swelling, enophthalmos or exophthalmos, diplopia, decreased visual acuity, limited eyeball movement and even blindness. A boy developed orbital and subcutaneous emphysema after forceful nose blowing. The patient had a history of a given slap 3 days ago, and no other evidence of trauma was complained of. At admission the patient presented with left eyelid swelling, proptosis and increased intraocular pressure of left eye (28 mmHg). The best-corrected visual acuity in the left eye was unchanged. No other abnormal findings in both eyes were found. Computer tomography revealed rupture of the lateral wall of left anterior ethmoid sinus, with free air leakage into left orbital region. After conservative treatment for 2 weeks, orbital emphysema had largely resolved. So repair was averted. There was no recurrence of orbital emphysema after follow-up for 6 months, and no other complication was found until now. We think that the slap was the underlying etiology in this patient.