Orbital emphysema: nose blowing leading to a blown orbit

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.