Without proper management can lead to cardiac life-threatening conditions such as cardiopulmonary embolism, cardiac tamponade, and respiratory distress, depending on the volume of air trapped under the facial soft tissues. Infection
Infections can spread beyond their initial location, including lamina papyracea. Signs and Symptoms
The signs and symptoms of orbital emphysema vary depending on the original cause, but it is preliminary associated with swelling, bruising, and tenderness around the impacted eye. It may also involve proptosis or the deterioration of vision, typically diplopia. The entrapped air may cause an acute increase in the intraocular pressure or vascular compromise that restrict ocular motility, prohibit the closure of eyelids, and the loss of sensation over the upper cheek areas.Server entrapment in the soft tissues tends to stimulate oculocardiac reflex, which is likely to generate significant vagal responses including nausea, dizziness, vomiting, bradycardia, syncope and heart block. Without treating it promptly may subsequently result in compromisation of ocular function and visual impairment. Pathophysiology
Orbital emphysema occurs following forceful injection of air into the soft tissues of the orbit through a breach in one of the orbital walls which is typically associated with orbital fracture after blunt trauma, or less frequently with compressed air injuries, tumours and infections of the sinonasal region or complications after surgery.Orbital emphysema develops after an orbital fracture in a three-step process. After the fracture has occurred on one of the orbital walls, a sino-orbital communication is established.
By reformatting these transverse images or taking coronal images, the examination of orbital floor and roof is permitted. Helical scanning is preferred as it has a lower imaging time and radiation dose comparing to conventional scanning, especially when reforming transverse helical scans into coronal images. The staging of orbital emphysema can then be determined with visual acuity examination and ophthalmoscopy. A disadvantage of using a CT scan is that when detecting air after orbital trauma, the presence of a wooden foreign object can give a false positive result of orbital emphysema. The wooden object can mimic the presence of orbital emphysema. Therefore, patients’ medical history is crucial in making the correct diagnosis. Other tests
Conventional radiography is commonly employed for imaging orbital injuries and identifying orbital fractures. It can be used to diagnose orbital emphysema because it shows the presence of air in the orbit best while the patient is standing upright. Skull films of posterior-anterior, lateral projections, and orbital rim views are recommended to show fractures in orbital rims and walls. However, CT scan is better than conventional radiography in the diagnosis of the condition, as it has a lower high false-negative rate and non-diagnostic rate.Orbital emphysema can also be diagnosed by magnetic resonance imaging (MRI). Although MRI has a low sensitivity for detecting orbital fractures, it can be used to evaluate rectus muscle pathology, optic nerve pathology, and brain pathology, as well as vascular injury. Treatment
Orbital emphysema on its own is a mild and self-limiting disease.