Periorbital emphysema in mechanical air blast injury

A young adult male presented to the emergency department, due to an accidental compressed air injury by high-pressurised air hoses, complaining of left-sided facial pain, swelling and an inability to open his left eye. The left eye appeared oedematous on clinical examination, with swelling extending to the premaxillary region. Additional findings included conjunctival chemosis, palpable crepitus and tears in the inferotemporal bulbar conjunctiva accompanied by subconjunctival haemorrhage. CT of the brain, orbits and facial bones revealed periorbital emphysema around the left orbit, with air pockets extending into the retroorbital, premaxillary region and masticator space. The patient was managed conservatively. Under aseptic conditions, a small conjunctival prick was made to facilitate air pocket evacuation. Oral and topical antibiotics were prescribed to prevent secondary infection. The patient was advised to follow-up in 14 days.