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

Area of Science:

• Ophthalmology
• Surgical Complications
• Orbital Surgery

Background:

• Orbital decompression surgery aims to improve outcomes for various orbital conditions.
• Post-operative complications require careful monitoring and management.
• Orbital emphysema is a rare but potentially vision-threatening complication.

Observation:

• A case series involving three patients undergoing bilateral orbital decompression.
• Patients experienced significant orbital emphysema linked to coughing and Valsalva maneuvers during extubation.
• Risk factors included persistent coughing and potentially the periorbita being opened.

Findings:

• No permanent visual or sensorimotor deficits were observed in the patients.
• Two patients resolved with observation; one required sedation and needle decompression.
• Violent coughing spells at extubation, more common in smokers, were implicated.

Implications:

• Acute orbital emphysema is a recognized risk after orbital decompression.
• Perioperative management strategies can help prevent this complication.
• Awareness of this phenomenon is crucial for ophthalmologists and surgeons.