Orbital emphysema is an uncommon condition occurring because of air trapped into loose subcutaneous tissue around the orbit commonly seen in cases with history of sinusitis, facial trauma or surgery. Lamina papyracea is the most common site of bony defect for passage of air from paranasal sinuses.
Orbital wall fracture is a common cause. Other causes include forceful nose blowing, post-surgical and pressure changes during air travel. Treatment options include observation as it is usually benign and spontaneous resolution occurs in two to three weeks.
However, it can cause ischemic optic neuritis and central retinal artery occlusion and may lead to visual loss. Hence when orbital emphysema shows signs of pressure effect like restricted ocular motility, sluggish pupillary reaction, disc edema or decreased visual acuity then drainage of trapped air in the subcutaneous tissue should be considered.
It can be done effectively by simple underwater drainage of air by 24-gauge needle or lateral canthotomy and cantholysis. The purpose of this article is to remind the readers about this simple and effective treatment of an uncommon condition to prevent potential visual loss.
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