Sub-Tenon Emphysema From Compressed Air Injury in a Patient With Marfan Syndrome

Compressed air injuries to the globe are rare and typically associated with orbital fractures or a visible entry wound. The authors report the case of a 16-year-old male with Marfan syndrome who developed orbital emphysema strictly confined to the sub-Tenon's space following a compressed air injury, without any visible entry wound or orbital fracture. Clinical examination demonstrated a well-demarcated subconjunctival air pocket located approximately 3-4 mm posterior to the limbus, consistent with the anterior insertion of Tenon's capsule. Computed tomography confirmed a localized intraorbital air without evidence of fracture or sinus communication. A plausible mechanism is that high-pressure air entered through microscopic tissue disruption and dissected along Tenon's capsule into the sub-Tenon space. The patient was managed conservatively with spontaneous resolution. This case provides a well-documented example of localized sub-Tenon emphysema and illustrates the anatomical boundaries of the sub-Tenon space in vivo.