Orbital emphysema: nose blowing leading to a blown orbit

Abstract

A 32-year-old woman with a painful swelling around the right eye few hours after blowing her nose, presented to the accident and emergency department. There was no associated history of facial trauma. Examination revealed a grossly swollen right eye and palpable subcutaneous emphysema. The patient's visual acuity and eye movements were normal. A CT scan of the orbit confirmed orbital emphysema secondary to a fracture of the floor of the orbit into the maxillary sinus, as a result of increased intranasal pressure during nose blowing. The patient was admitted and managed conservatively with antibiotics. She made a full recovery with complete resolution of all her symptoms. A nasal bone fracture was also seen on CT scan and even though the patient could not recall any history of facial trauma, it was an incidental finding.

Figure 1

Gross swelling around the right eye can be seen due to subcutaneous emphysema.

Figure 2

Lateral view of the right eye demonstrating swollen upper and lower eyelids.

Figure 3

CT scan showing orbital emphysema of the right eye.

Figure 4

Close up view showing fracture of the floor of the right orbit into the maxillary sinus.

Figure 5

Fracture of the nasal bone on the right.

Figure 6

Optic nerve showing no signs of compression (yellow arrow). Also note there is massive emphysema around the eye (red arrow).

Figure 7

Air locules are seen in the retro-orbital space.