Emergency decompression of tension retrobulbar emphysema secondary to orbital floor fracture
A 49-year-old woman was referred to our department of Oral and Maxillofacial Surgery with a history of blunt trauma in the region of the left eye incurred in a fall 1 day earlier. As there was no functional disturbance, she did not seek medical help initially. The next day, while blowing her nose she developed swelling, pain and progressive loss of vision. Physical examination revealed severe left-sided exophthalmos, accompanied by palpebral and orbital swelling and subconjunctival hematoma. Eye movement in all directions was painful. There was no diplopia at the first ophthalmological evaluation, but a loss of visual acuity of 6/10, accompanied by severe proptosis and increased intraocular pressure (IOP) were indications for rapid surgical treatment.\nSpiral computed tomography (CT) was performed using 1 mm slices with a soft tissue and bone algorithm. A non-dislocated orbital floor fracture and a large amount of intraorbital emphysema were found, especially retrobulbar between the ocular muscles and around the optic nerve, causing exophthalmos (the distance from the corneal apex to the line connecting orbital rims was 18.8 mm; normal 9.0 mm) (Figs –).\nOwing to the clinical findings and the severity of the symptoms, surgical decompression was performed under general anesthesia. Lateral blepharoplasty and transconjunctival incisions were made (Fig. ). The left orbital floor was exposed, revealing a non-dislocated bone defect, without herniation of the periorbital tissue. The surgical management with orbital drainage produced excellent results, with sudden resolution of the proptosis and a postoperative improvement in visual acuity, confirmed by further ophthalmological evaluation (Figs –). The patient was put on amoxicillin and clavulanic acid every 8 h, and advised not to blow her nose vigorously and to use a nasal decongestant.\nTwo days after surgery, the patient was discharged with restored visual acuity and continuing resolution of the left periorbital swelling and proptosis.