Bilateral periorbital and cervicofacial emphysema following retinal surgery and fluid gas exchange in a case of inadvertent globe perforation

Abstract

Surgical emphysema is defined as gas or air trapped in the subcutaneous tissue plane. Here, we report a rare case of bilateral periorbital and cervicofacial subcutaneous emphysema following a vitreoretinal surgery for inadvertent globe perforation during the administration of peribulbar anesthesia. This condition, although self-resolving when restricted to the subcutaneous plane has the potential to spread into deeper tissue planes such as the retropharyngeal space. The presence of crepitus helps to distinguish it from angioneurotic edema. Ophthalmologists must be sensitive to the fact that surgical emphysema can be a very rare, but possible complication of an intraocular surgery following globe perforation.

Figure 1

External photograph taken immediately after the surgery demonstrating the bilateral subcutaneous emphysema (a), extending up to the level of the chest on both sides (b and c; black arrowheads)

Figure 2

(a) Line drawing showing the needle tract, which served as the path of least resistance for the escaping air. Points A and B indicate the possible points of scleral perforation and point C indicates the site of the retinal break. (b) Line drawing showing the possible route taken by the air to escape, through the scleral opening and conjunctiva (D), into the orbital tissue. And through the orbital septum (E) and muscular plane and into the subcutaneous plane (F). The passage of the air being facilitated by the previously created needle tract (a)