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Orbital emphysema and diplopia following thoracotomy
1Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, USA.
European Journal of Ophthalmology
|January 29, 2000
Summary
Subcutaneous emphysema after thoracotomy can cause diplopia and orbital emphysema. This case suggests air entered the orbit via the inferior orbital fissure, resolving with chest tube management.
Area of Science:
- Ophthalmology
- Thoracic Surgery
- Radiology
Background:
- Diplopia and orbital emphysema are rare complications following thoracic surgery.
- Subcutaneous emphysema can occur post-thoracotomy, but orbital involvement is not well-documented without direct trauma.
Observation:
- A 71-year-old woman presented with new-onset diplopia several days after undergoing thoracotomy.
- Physical examination revealed diffuse subcutaneous emphysema and right hypertropia.
- Head computed tomography (CT) demonstrated subcutaneous emphysema in the face and eyelids, extending into the infratemporal fossa and orbits bilaterally.
Findings:
- Computed tomography imaging indicated that air entered the orbit through the inferior orbital fissure.
- The patient's diplopia resolved after the chest tube was replaced.
Implications:
- This case highlights that subcutaneous emphysema can cause orbital emphysema and diplopia without direct orbital trauma.
- The findings suggest a specific pathway (inferior orbital fissure) for air entry into the orbit in such cases.
- Understanding this mechanism can inform clinical management and potentially prevent similar complications in patients undergoing thoracic procedures.