Abstract
Orbital emphysema occurs when air enters the soft tissue surrounding the orbit. Although orbital blowout fractures are often caused by face trauma, nontraumatic orbital fractures can also occur but have been rarely described. Here, a case of orbital and palpebral emphysema caused by forceful nose-blowing is presented. Examination uncovered gross swelling of the right eye and discernable subcutaneous emphysema. The patient had normal eye movement and visual acuity. Orbital computed tomography (CT) revealed orbital emphysema secondary to an orbit floor fracture into the maxillary sinus, resulting from high intranasal pressure upon blowing her nose. The patient received conservative management with antibiotics and was given instructions not to sneeze or blow her nose. She fully recovered and all her symptoms completely resolved.
Highlights
Orbital emphysema is a somewhat rare clinical event
We describe a patient with orbital emphysema presenting swelling surrounding the left eye several hours after blowing her nose
Case Reports in Emergency Medicine periorbital emphysema had partially resolved with normal intraocular pressure. This case highlights spontaneous orbital emphysema caused by forceful nose-blowing, which may pose a diagnostic challenge
Summary
Orbital emphysema is a somewhat rare clinical event. A collection of air within the orbits or eyelids is most commonly associated with fracture and trauma of an orbital bone. Trauma is the most common etiology of orbital emphysema, nontraumatic spontaneous orbital emphysema due to coughing, sneezing, nose blowing, or any type of straining as a result of iatrogenic otolaryngeal and dental procedures and infectious gas-producing microorganisms have been described [1,2,3,4,5]. Most cases of orbital emphysema resolve spontaneously; emergency physicians should be aware that early recognition of orbital emphysema is crucial to prevent possible vision-threatening complications if unrecognized [6]. Since orbital emphysema with no prior history of trauma is a very rare condition in the emergency medicine setting, sharing our experience and review of previous reports of this condition may help emergency physicians decide on therapeutic strategies and initiate immediate management
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