Late Subconjunctival Emphysema in an Unrepaired Orbital Floor Fracture

A 42-year-old gentleman with a history of a left orbital floor fracture four years prior presented to the emergency department following a motor vehicle collision. He was without subjective eye concerns, although a physical examination revealed a superior temporal subconjunctival mass with crepitus of the left eye. Visual acuity was 20/20 bilaterally, pupils were reactive without a relative afferent pupillary defect, and extraocular movement was fully intact. A computed tomography scan of the face revealed left-sided subconjunctival, subcutaneous, and orbital emphysema determined to be associated with a previous orbital floor fracture. With no other medical concerns requiring immediate treatment, the patient was offered outpatient repair of the old orbital floor fracture.