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Orbital Emphysema

A Case Report and Comprehensive Review of the Literature

Roelofs, Kelsey A., M.D.*; Starks, Victoria, M.D.; Yoon, Michael K., M.D.

Ophthalmic Plastic & Reconstructive Surgery: January/February 2019 - Volume 35 - Issue 1 - p 1–6
doi: 10.1097/IOP.0000000000001216
Major Reviews

Purpose: The objective of this study was to report a case of persistent and likely self-induced orbital emphysema (OE) following functional endoscopic sinus surgery with dislodgement of a previously placed orbital floor implant and to review the literature surrounding etiologies, pathophysiology, and management of OE.

Methods: Case report and review of the literature.

Results and Discussion: While blunt trauma resulting in disruption of the medial orbital wall is the most common cause of OE, there are an additional 25 underlying etiologies reported in the current literature. Pathophysiology of OE is somewhat dependent on underlying etiology but often involves a 1-way ball valve mechanism such that air may enter the orbit but not exit. When sufficient air enters the orbit, complications secondary to increased intraorbital pressure, including central retinal artery occlusion and compressive optic neuropathy, can occur. Mild cases of OE are typically observed, with most resolving within 7 to 10 days. Moderate cases are often managed by lateral canthotomy and cantholysis with possible needle decompression. Severe cases may require urgent surgical decompression. While the majority of cases of OE are benign and self-limited, there have been 4 reports in the literature documenting significant vision loss.

Conclusions: Although there is often a history of trauma in patients presenting with OE, many other underlying etiologies have been reported with several cases occurring spontaneously. As such, OE should be included on the differential for a patient presenting with a sudden onset of orbital signs.

Herein the authors present a case of persistent orbital emphysema (OE) following exchange of an orbital floor implant and review the etiologies, pathophysiology, and management of OE.

*Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

Ophthalmic Plastic and Reconstructive Surgery Service, Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.

Accepted for publication July 10, 2018.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Michael K. Yoon, M.D., Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye & Ear Infirmary, 243 Charles Street, Boston, MA 02114. E-mail:

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.