Periorbital Emphysema Due to Traumatic Pneumothorax

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Ophthalmology

Background:

• Periorbital emphysema is a rare condition typically associated with facial trauma, characterized by subcutaneous air in the eyelid region.
• While often benign and self-resolving, it can rarely lead to orbital compartment syndrome, potentially causing vision loss.

Observation:

• A 55-year-old male presented with bilateral periorbital edema after a fall, initially treated as an allergic reaction without improvement.
• The patient subsequently developed acute dyspnea, revealing a left pneumothorax on chest X-ray.
• Imaging confirmed extensive subcutaneous emphysema, indicating significant trauma.

Findings:

• The case demonstrates periorbital emphysema in the context of chest trauma, not just direct facial injury.
• Non-response to antihistamines and corticosteroids suggested a non-allergic etiology.
• The development of pneumothorax and widespread subcutaneous emphysema indicated severe underlying trauma.

Implications:

• This case underscores the importance of considering traumatic causes in the differential diagnosis of periorbital edema, even without obvious facial injury.
• Prompt recognition and management of associated injuries, such as pneumothorax, are crucial for patient outcomes.
• The presentation challenges the typical association of periorbital emphysema solely with direct facial trauma.