Post traumatic orbital emphysema

Case contributed by Nikos Karapasias

Presentation

Sudden and painless onset of left periorbital swelling and nose-bleed following forceful blowing of the nose. He felt like the skin around his eye "puffed out". The patient recalls blowing his nose to evacuate blood after facial trauma during kick boxing training.

Patient Data

Age: 20 years
Gender: Male
x_ray

Air density around the left superior orbital margin, suggestive of orbital emphysema. The black eyebrow sign is shown.
Mucosal thickening of the left maxillary sinus with air-fluid level.

Fracture of the left medial orbital wall, a small herniation of orbital fat through the fracture, and orbital emphysema. Incidental fluid level with mucosal thickening of the left maxillary sinus (probably chronic sinusitis).

Case Discussion

Orbital emphysema is a benign self limiting condition and typically results from forceful entry of air into the orbital soft tissue spaces following an orbital fracture. No treatment is required unless there are associated visual symptoms.

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