In the October 2005 issue of the ARCHIVES, Rubinstein et al1 described a patient who experienced an orbital compartment syndrome causing complete vision loss following functional endoscopic sinus surgery. Although the most common cause of orbital compartment syndrome is hemorrhage, other causes do exist, including emphysema as described in this case. Clinical signs that may point to the possibility of orbital emphysema as a source of orbital compartment syndrome include periorbital crepitus, subconjunctival emphysema (air bubbles within the conjunctiva), or vertical globe dystopia, as free air in the orbit tends to accumulate superiorly and displace the eye inferiorly. After being diagnosed with a tight orbit, the patient in this case had an imaging study done and was hospitalized overnight. After waking with no light perception, he was taken to surgery. Rubinstein and colleagues concluded that “emphysema usually resorbs spontaneously without permanent visual damage. However, if the vision deteriorates, rapid action must be taken. . . . ”
Hatton MP, Rubin PAD. Management of Orbital Compartment Syndrome. Arch Ophthalmol. 2007;125(3):433–434. doi:10.1001/archopht.125.3.433-b
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