20/20 to NLP due to Blowing the Nose and Orbital Emphysema: A Case Report

Orbital emphysema is characterized by presence of air in the soft tissues of the orbits. In severe cases, this can lead to orbital compartment syndrome, a medical emergency that can result in severe permanent vision loss without urgent intervention. Generally, the severity of presenting vision loss and longer time to intervention have been associated with worse visual outcome.

We present the case of a 26-year-old healthy male who developed an acute orbital compartment syndrome with orbital emphysema following nose blowing in the setting of a bacterial orbital cellulitis. Once documented to have no light perception (NLP) vision in the affected eye, he was urgently taken to the operating room for surgical drainage (approximately 2.5 h after onset of the NLP). Over the subsequent days, he gradually regained 20/20 visual acuity.

This case highlights that despite complete loss of vision, this patient had an excellent visual outcome.