Orbital Subcutaneous Emphysema in a Child.

Area of Science:

• Ophthalmology
• Pediatric Medicine
• Otolaryngology

Background:

• Orbital wall fractures are typically traumatic.
• Nose blowing is a common activity, especially in children.
• Medial orbital wall fractures are less common than other orbital fractures.

Observation:

• An 11-year-old girl presented with periorbital swelling after vigorous nose blowing.
• She had a history of chronic forceful nose blowing.
• Initial diagnoses included sinusitis and periorbital cellulitis, leading to antibiotic treatment.

Findings:

• A rare case of nontraumatic medial orbital wall fracture was identified.
• This is the first reported instance of orbital wall fracture secondary to nose blowing in a pediatric patient.
• The authors propose that repeated forceful nose blowing acts similarly to stress fractures, weakening the medial orbital wall.

Implications:

• Forceful nose blowing should be considered a potential cause of medial orbital wall fractures in children.
• This case may prompt a re-evaluation of diagnostic approaches for pediatric periorbital swelling.
• Understanding this mechanism can prevent misdiagnosis and unnecessary antibiotic use.