Self-induced orbital emphysema as a presenting sign of Munchausen's syndrome

A bizarre case of severe, debilitating pneumo-orbit resulting in proptosis, blindness, and eventual exenteration of the right eye and threatening the same fate for the left eye was worked up painstakingly for over 10 years before a final diagnosis of Munchausen's syndrome was uncovered. Five days after the diagnosis was made and appropriate management was instituted the severely proptotic left eye had returned to normal and the patient was discharged for out-patient psychiatric follow-up. A discussion of the differential diagnosis of pneumo-orbit is presented and Munchausen's syndrome, the final diagnosis in this case, is discussed from both an historical and psychiatric perspective.