Recurrent Self-Induced Nontraumatic Orbital Emphysema Causing Orbital Compartment Syndrome with Optic Nerve...

Area of Science:

• Ophthalmology
• Emergency Medicine
• Radiology

Background:

• Orbital emphysema typically results from trauma, with complications and surgical needs being uncommon.
• Nontraumatic orbital emphysema is exceptionally rare, and its potential to cause severe complications like orbital compartment syndrome is not well-documented.

Observation:

• A 51-year-old male presented with unilateral proptosis, decreased visual acuity, and diplopia following a Valsalva maneuver, with no history of trauma.
• The patient reported recurrent transient proptosis after Valsalva maneuvers over the preceding year.
• Ophthalmological examination revealed reduced visual acuity (6/21), a relative afferent pupillary defect, and normal intraocular pressure (12 mmHg).

Findings:

• Computed tomography (CT) scan confirmed significant orbital emphysema in the medial aspect of the right orbit.
• The patient underwent emergency needle decompression, which led to immediate symptom resolution.
• This case highlights that a lack of trauma history and normal intraocular pressure do not exclude serious orbital pathology in cases of orbital emphysema.

Implications:

• Orbital emphysema can present without trauma and lead to vision-threatening complications such as orbital compartment syndrome.
• Emergency needle decompression is an effective treatment for vision compromise due to orbital emphysema.
• Clinicians should maintain a high index of suspicion for serious orbital pathology in patients with orbital emphysema, even in the absence of trauma or elevated intraocular pressure.