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Ophthalmic Images

Unilateral orbital emphysema in a COVID-19 patient

Das, Deepsekhar1,2,; Anwer, Zakia2; Kumari, Neha2; Gupta, Stuti3

Author Information
Indian Journal of Ophthalmology: November 2020 - Volume 68 - Issue 11 - p 2535
doi: 10.4103/ijo.IJO_2385_20
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A 42-year-old male got admitted with COVID-19 related acute respiratory distress syndrome (ARDS). A Portex 7.5 French triple lumen catheter was placed in the right subclavian vein and trachea was intubated using a 7.5 mm endotracheal tube Rusch. On administering high positive end expiratory pressure ventilation, he developed subcutaneous emphysema over chest which progressed to the right side of his face involving the right orbit [Fig. 1a]. On examination, palpable crepitus was noted in the periocular region with subconjunctival collection of air [Fig. 1b]. Direct and consensual pupillary reflexes were normal. Bilateral intercostal drainage tubes were placed [Fig. 1c]. The emphysema spontaneously resolved in the following 2 days.

Figure 1
Figure 1:
(a) Clinical picture showing swelling of the right side of the face along with upper and lower eyelid fullness. (b) Clinical picture showing presence of subconjunctival air. (c) Chest radiogram showing subcutaneous emphysema, 2 chest drainage tubes in situ, central line in situ, and lung parenchymal disease

Orbital emphysema usually occurs after trauma and resolve spontaneously.[1] They are of three types: Palpebral, True, and Orbito-palpebral.[2] However, spontaneous orbital emphysema in COVID-19 ARDS has also been reported.[3] Subcutaneous emphysema of thorax develops from pneumothorax barotrauma in a mechanically ventilated patient, and then air migrates to the orbit.[4] Unilaterality in this case is because the patient was lying on a left lateral position.

2.1 Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

2.2 Financial support and sponsorship

Nil.

2.3 Conflicts of interest

There are no conflicts of interest.

References

Gauguet J, Lindquist PA, Shaffer K. Orbital emphysema following ocular trauma and sneezing Radiol Case Rep. 2008;3:124
Heerfordt CF. Über das emphysem der orbita Albrecht von Graefes Arch für Ophthalmol. 1904;58:123–50
Stevens DV, Tran AQ, Kim E. Complications of orbital emphysema in a COVID-19 patient Ophthalmology. 2020;127:990
Aghajanzadeh M, Dehnadi A, Ebrahimi H, Karkan MF, Jahromi SK, Maafi AA, et al Classification and management of subcutaneous emphysema: A 10-Year experience Indian J Surg. 2015;77(Suppl 2):673–7
© 2020 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow