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   Table of Contents      
OPHTHALMIC IMAGE
Year : 2020  |  Volume : 68  |  Issue : 11  |  Page : 2535

Unilateral orbital emphysema in a COVID-19 patient


1 Oculoplastic, Paediatric Ophthalmology and Oncology Services; Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
2 Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
3 Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication26-Oct-2020

Correspondence Address:
Dr. Deepsekhar Das
Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2385_20

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How to cite this article:
Das D, Anwer Z, Kumari N, Gupta S. Unilateral orbital emphysema in a COVID-19 patient. Indian J Ophthalmol 2020;68:2535

How to cite this URL:
Das D, Anwer Z, Kumari N, Gupta S. Unilateral orbital emphysema in a COVID-19 patient. Indian J Ophthalmol [serial online] 2020 [cited 2020 Nov 24];68:2535. Available from: https://www.ijo.in/text.asp?2020/68/11/2535/299061



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 [Figure 1]a. On examination, palpable crepitus was noted in the periocular region with subconjunctival collection of air [Figure 1]b. Direct and consensual pupillary reflexes were normal. Bilateral intercostal drainage tubes were placed [Figure 1]c. The emphysema spontaneously resolved in the following 2 days.
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

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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.

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gauguet J, Lindquist PA, Shaffer K. Orbital emphysema following ocular trauma and sneezing. Radiol Case Rep 2008;3:124.  Back to cited text no. 1
    
2.
Heerfordt CF. Über das emphysem der orbita. Albrecht von Graefes Arch für Ophthalmol 1904;58:123-50  Back to cited text no. 2
    
3.
Stevens DV, Tran AQ, Kim E. Complications of orbital emphysema in a COVID-19 patient. Ophthalmology 2020;127:990.  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
    


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