Description

Most of the time orbital emphysema is a minor condition, but it can be a medical emergency if severe. An increase in pressure within the orbit can compress the globe, resulting in a compartment syndrome.


Parameters:

(1) amount of intra-orbital air

(2) signs and symptoms

(3) risk

 

Amount of Air

Signs/Symptoms

Risk

Stage

small (may only be seen on X-rays)

none

none

I

moderate, with globe displacement

proptosis, diplopia, lateral shift of globe

minimal

II

marked, with increased intra-ocular pressure

reduced vision

ischemic injury to optic nerve

III

marked, with high intra-ocular pressure

visual loss

permanent blindness from central retinal artery occlusion

IV

 

Intraorbital needle decompression can quickly reduce the pressure and preserve vision. Shameer et al described using a 23-gauge needle attached to a saline-filled syringe (? via butterfly) with the plunger removed.


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