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Severe orbitopalpebral emphysema after nose blowing requiring emergency decompression
J J García-Medina1, M García-Medina, M D Pinazo-Durán
1Ophthalmology Research Unit, Santiago Grisolia, Department of Ophthalmology, University Hospital Doctor Peset, Valencia, Spain. josegarciam@yahoo.com
European Journal of Ophthalmology
|May 17, 2006
Summary
Severe orbital emphysema can result from forceful nose blowing, causing eyelid swelling and proptosis. Emergency needle decompression may be necessary to assess vision and prevent potential ischemic loss.
Area of Science:
- Ophthalmology
- Otorhinolaryngology
- Emergency Medicine
Background:
- Orbital emphysema, often linked to medial wall fractures from blunt trauma, is typically benign.
- Severe cases requiring intervention are rare, especially without significant trauma history.
Observation:
- A 51-year-old woman presented with severe left orbital swelling and proptosis after forceful nose blowing during a cold.
- CT scan revealed extensive orbitopalpebral emphysema and a medial orbital wall fracture.
- Needle decompression was required for ophthalmic examination.
Findings:
- The patient experienced significant relief and near-complete resolution of swelling within 28 hours post-decompression.
- No significant ocular damage was found, allowing for outpatient management.
- Forceful expiratory efforts can lead to orbital wall fractures and subsequent emphysema.
Implications:
- Vigorous nose blowing can cause orbital fractures and severe emphysema.
- Emergency decompression is crucial when vascular compression is suspected to preserve vision.
- This case highlights the potential for severe outcomes from seemingly minor actions.