Suck and spit, don’t blow: orbital emphysema after decompression surgery

Abstract

PurposeTo describe the occurrence of vision-threatening orbital emphysema in patients awakening from orbital decompression surgery and to assess risk factors and preventive measures. DesignSmall noncomparative case series. ParticipantsThree patients undergoing bilateral orbital two-wall decompression experienced significant orbital emphysema associated with persistent coughing and Valsalva at the time of extubation. InterventionIn two patients, symptoms resolved with simple observation, whereas one patient required sedation, topical anesthesia around the endotracheal tube, and needle decompression of trapped air. Main outcome measuresVisual acuity, pupils, visual fields, and sensorimotor examination. ResultsNo patient experienced a permanent deficit of visual or sensorimotor function. ConclusionsAcute orbital emphysema can occur after orbital decompression surgery despite the large bony opening created. Violent coughing spells at the time of extubation are more common in patients with a history of heavy tobacco use and may be causative. Opening the periorbita may be another specific predisposing risk factor. Knowledge of this dangerous phenomenon, along with appropriate perioperative management, may prevent this complication from occurring.