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Orbital Emphysema From Chronic Intranasal Cocaine Use
Gio Manguerra1, Wesley Eilbert1
1Department of Emergency Medicine, University of Illinois, College of Medicine, Chicago, Illinois.
The Journal of Emergency Medicine
|February 18, 2026
Summary
Chronic intranasal cocaine use can lead to orbital emphysema, causing eye proptosis. Emergency physicians must recognize this condition and its link to sinonasal structure damage for appropriate management.
Area of Science:
- Otolaryngology
- Ophthalmology
- Emergency Medicine
Background:
- Chronic intranasal cocaine use can destroy sinonasal osteocartilaginous structures.
- This destruction can create abnormal pathways between sinuses and the orbit.
- Such communication may lead to orbital emphysema.
Purpose of the Study:
- To highlight the association between chronic intranasal cocaine use and orbital emphysema.
- To inform emergency physicians about this potential complication.
- To emphasize the need for prompt diagnosis and management.
Main Methods:
- Case report of a 47-year-old male with a history of chronic intranasal cocaine use.
- Presentation with recurrent right eye proptosis, exacerbated by nose blowing.
- Maxillofacial computed tomography (CT) revealed right orbital emphysema and ethmoid sinus destruction.
Main Results:
- The patient exhibited significant right orbital emphysema.
- CT scan demonstrated destruction of the lateral border of the right ethmoid sinus.
- Symptoms were directly linked to cocaine-induced sinonasal damage.
Conclusions:
- Orbital emphysema is a potential consequence of chronic intranasal cocaine use.
- Damage to midface sinuses from cocaine abuse can result in orbital emphysema.
- Emergency physicians must be aware of this association for timely diagnosis and treatment.
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