Suck and spit, don't blow: orbital emphysema after decompression surgery

Abstract

Purpose: To describe the occurrence of vision-threatening orbital emphysema in patients awakening from orbital decompression surgery and to assess risk factors and preventive measures.

Design: Small noncomparative case series.

Participants: Three patients undergoing bilateral orbital two-wall decompression experienced significant orbital emphysema associated with persistent coughing and Valsalva at the time of extubation.

Intervention: In two patients, symptoms resolved with simple observation, whereas one patient required sedation, topical anesthesia around the endotracheal tube, and needle decompression of trapped air.

Main outcome measures: Visual acuity, pupils, visual fields, and sensorimotor examination.

Results: No patient experienced a permanent deficit of visual or sensorimotor function.

Conclusions: Acute orbital emphysema can occur after orbital decompression surgery despite the large bony opening created. Violent coughing spells at the time of extubation are more common in patients with a history of heavy tobacco use and may be causative. Opening the periorbita may be another specific predisposing risk factor. Knowledge of this dangerous phenomenon, along with appropriate perioperative management, may prevent this complication from occurring.