Orbital Emphysema
A 63-year-old man presented to the emergency department with a 1-day history of double vision and a “bubbly appearance” of the left eye after he fell and struck his face on a concrete floor. On physical examination, air bubbles were seen in the bulbar conjunctiva of the left eye (Panel A), along with periorbital swelling, crepitus of the upper and lower eyelids, and restriction of upward, downward, and lateral eye movements on the left side. Visual acuity in the left eye was 20/400, and the intraocular pressure was 25 mm Hg (reference range, 12 to 20). Results of an examination of the right eye were normal. Computed tomography of the face showed periorbital subcutaneous (Panel B, asterisks) and retrobulbar emphysema, fractures of the inferior orbital rim, and an intact globe on the left side. A diagnosis of traumatic orbital emphysema was made. Traumatic orbital emphysema occurs when an orbital fracture allows air to pass from a sinus into the orbit. When an orbital fracture occurs, the globe should be thoroughly evaluated for injury. A needle decompression of the conjunctiva was performed. After the procedure, the patient’s visual acuity improved to 20/200. The patient was discharged with instructions to use a topical antibiotic, eye lubricant, and brimonidine but was subsequently lost to follow-up.