Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 4418
  • Home
  • Print this page
  • Email this page

   Table of Contents      
Year : 2007  |  Volume : 55  |  Issue : 5  |  Page : 395

Spontaneous subcutaneous orbital emphysema following forceful nose blowing: Treatment options

Government Hospital, Daman (U.T.), India

Correspondence Address:
N Shah
Sanskruti Apartment, Flat No.208, Airport Road, Daman (Union Territory) 396 210
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.33834

Rights and Permissions

How to cite this article:
Shah N. Spontaneous subcutaneous orbital emphysema following forceful nose blowing: Treatment options. Indian J Ophthalmol 2007;55:395

How to cite this URL:
Shah N. Spontaneous subcutaneous orbital emphysema following forceful nose blowing: Treatment options. Indian J Ophthalmol [serial online] 2007 [cited 2020 May 30];55:395. Available from: http://www.ijo.in/text.asp?2007/55/5/395/33834

Dear Editor,

A 28-year-old man presented with sudden and painless onset of left periorbital swelling following forceful blowing of nose. There was no history of sinusitis, facial trauma or previous surgery. On examination there was massive non-tender left periorbital swelling with crackling sound (crepitus) on palpation suggestive of subcutaneous orbital emphysema. On lid retraction there was mild proptosis with conjunctival congestion. Ocular movements, pupillary reactions and dilated fundus examination were normal. The visual acuity was 20/20. Right eye examination was normal. The patient was kept under observation. After 48h the visual acuity in left eye dropped to 20/60 with increase in conjunctival congestion associated with disc edema and slight relative segmental pallor of disc suggestive of compressive optic neuropathy. We decided to drain the trapped subcutaneous air. Under aseptic conditions a 24-gauge needle mounted on 10 ml syringe filled with normal saline and plunger removed was introduced in the periorbital tissue. The subcutaneous emphysema was drained which was guided by air bubble eruption. After this treatment, in the next 48h there was considerable decrease in periorbital swelling, conjunctival congestion and disc edema and visual acuity improved to 20/30. After three weeks left eye returned to normal with visual acuity of 20/20.

Orbital emphysema is an uncommon condition occurring because of air trapped into loose subcutaneous tissue around the orbit commonly seen in cases with history of sinusitis, facial trauma or surgery. Lamina papyracea is the most common site of bony defect for passage of air from paranasal sinuses. [1] Orbital wall fracture is a common cause. [2] Other causes include forceful nose blowing, [1] post-surgical and pressure changes during air travel. Treatment options include observation as it is usually benign and spontaneous resolution occurs in two to three weeks. [3] However, it can cause ischemic optic neuritis [4] and central retinal artery occlusion and may lead to visual loss. Hence when orbital emphysema shows signs of pressure effect like restricted ocular motility, sluggish pupillary reaction, disc edema or decreased visual acuity then drainage of trapped air in the subcutaneous tissue should be considered.[5] It can be done effectively by simple underwater drainage of air by 24-gauge needle [2] or lateral canthotomy and cantholysis. The purpose of this article is to remind the readers about this simple and effective treatment of an uncommon condition to prevent potential visual loss.

  References Top

Mohan B, Singh KP. Bilateral sub-cutaneous orbital emphysema of orbit following nose blowing. J Laryngol Otol 2001;115:319-20.  Back to cited text no. 1
Benharbit M, Karim A, Lazreq M, Mohcine Z. Emergency treatment of post-traumatic orbital emphysema: A case report. J Fr Ophthalmol 2003;26:957-9.  Back to cited text no. 2
Wearne MJ, Frank J, Bryan S. Management of orbital emphysema. Eye 1998;12:1016-7.  Back to cited text no. 3
Fleishman JA, Beck RW, Hoffman RO. Orbital emphysema as an ophthalmologic emergency. Ophthalmology 1984;91:1389-91.  Back to cited text no. 4
Dobler AA, Nathenson AL, Cameron JD. A case of orbital emphysema as an ocular emergency. Retina 1993;13:166-8.  Back to cited text no. 5

This article has been cited by
1 Persisting Subcutaneous Emphysema of Eyelids Mimicking Orbital Tumor
Cristina Bozzola,Andrea Toso,Gloria Golinelli,Arnaldo Benech,Paolo Aluffi,Renzo Boldorini
Journal of Craniofacial Surgery. 2013; 24(5): 1685
[Pubmed] | [DOI]
2 Enfisema orbitrio compressivo apos asseio nasal: relato de caso
de Albuquerque Furlani, B.
Arq Bras Oftalmol. 2009; 72(2): 251-3
3 Sight-threatening orbital emphysema after nose blowing: Case report | [Enfisema orbitário compressivo após asseio nasal: Relato de caso]
de Albuquerque Furlani, B., Diniz, B., Bitelli, L.G., Martins, E.N.
Arquivos Brasileiros de Oftalmologia. 2009; 72(2): 251-253
4 Barotrauma: A Complication of Positive Pressure for Nasal Foreign Body Removal in a Pediatric Patient
Rachel W. Hills,Julie C. Brown,Dena Brownstein
Annals of Emergency Medicine. 2008; 52(6): 623
[Pubmed] | [DOI]
5 Orbital and infratemporal fossa emphysema following nose blowing
F. Di Lella,A. Bacciu,V. Vincenti,E. Pasanisi,S. Bacciu
Clinical Otolaryngology. 2008; 33(2): 181
[Pubmed] | [DOI]
6 Barotrauma: A Complication of Positive Pressure for Nasal Foreign Body Removal in a Pediatric Patient
Hills, R.W. and Brown, J.C. and Brownstein, D.
Annals of Emergency Medicine. 2008; 52(6): 623-625
7 Orbital Emphysema Following Ocular Trauma and Sneezing
Gauguet, J.M. and Lindquist, P. and Shaffer, K.
Radiology Case Reports. 2008; 3(1)
8 Orbital and infratemporal fossa emphysema following nose blowing
Di Lella, F. and Bacciu, A. and Vincenti, V. and Pasanisi, E. and Bacciu, S.
Clinical Otolaryngology. 2008; 33(2): 181-182


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article

 Article Access Statistics
    PDF Downloaded219    
    Comments [Add]    
    Cited by others 8    

Recommend this journal