According to Brav,1 orbitopalpebral emphysema is not a very common condition, but when found it is always of traumatic origin and secondary to a fracture of the nasal orbital wall. Contusion over the orbital area with resultant driving of the eyeball into the orbit and recession of the orbital fat to one side may alone result in fracture by direct contact of eyeball and orbital wall. The common points for this type of fracture are in the lacrimal and ethmoidal bones. The lamina papyracea of the ethmoid bone, a smooth, very thin quadrilateral plate which encloses the ethmoidal cells and forms a large part of the medial wall of the orbit, is the most logical point of fracture.
After fracture, on blowing the nose or sneezing, nasal pressure is built up so that air is forced into the orbital cavity or even into the lids if the pressure is
Linhart WO. EMPHYSEMA OF THE ORBIT: A STUDY OF SEVEN CASES. JAMA. 1943;123(2):89–90. doi:10.1001/jama.1943.82840370002006a
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