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September 1985

Subconjunctival Emphysema Associated With Mechanical Ventilation

Author Affiliations

San Francisco

Arch Ophthalmol. 1985;103(9):1277-1278. doi:10.1001/archopht.1985.01050090029014

To the Editor.  —Patients requiring mechanical ventilation often suffer forms of pulmonary barotrauma as complications of treatment. Such complications as subcutaneous emphysema, pneumomediastinum, and pneumothorax may be associated with the use of positive-end expiratory pressure (PEEP).1 To our knowledge, only one case of subconjunctival emphysema has been reported in association with mechanical ventilation therapy.2 We report herein a second case of subconjunctival emphysema associated with PEEP.

Report of a Case.  —A 28-year-old woman was admitted to an intensive care unit for treatment of acute respiratory distress secondary to asthma. Despite aggressive treatment with corticosteroids and bronchodilators, she ultimately required intubation and mechanical ventilatory assistance with PEEP at 2 to 5 cm H2O. After approximately 24 hours, subcutaneous emphysema developed, involving the neck and both eyelids. Chest roentgenograms did not demonstrate pneumomediastinum or pneumothorax. Ophthalmic consultation was requested for evaluation of bilateral lid and conjunctival swelling, and

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