ORBITOPALPEBRAL EMPHYSEMA IN RESOURCE-LIMITED ENVIRONMENT.A CASE REPORT

Abstract

Background: Orbital Emphysema(OE) is the presence of air in the periorbital soft tissues. The most common cause is orbital wall fractures. However, other causes include infections secondary to gas-producing microorganisms, pulmonary barotrauma, airplane trips, intubation barotrauma, frontal sinus osteomas, and other iatrogenic causes. Non-traumatic causes, such as nose blowing and lifting weights, have also been reported. Though computer tomography (CT) is the gold standard diagnostic investigation, OE is radiologically detected in only 50% of orbital wall fractures. When not well managed, there is an increase in intra-orbital pressure leading to compressive effects on the central retinal artery and optic nerve, resulting in blindness.

Results: in the case here, OE was diagnosed clinically in the absence of a CT scan, yet supported by a B-scan that revealed hyper-echoic air collection with acoustic shadowing, and thereafter the patient was managed conservatively.

Conclusion:  In resource resource-limited environment, a high index of suspicion for orbital wall fractures in orbital emphysema should prompt the attending clinician to advise the patient appropriately against Valsalva maneuvers.