ORBITAL FRACTURE BUBBLES

Published 2023 - 27th ESCRS Winter Meeting

Reference: P001 | Type: Presented Poster & Poster Submission | DOI: 10.82333/a07z-f379

Authors: Luis Alcalde Blanco ¹ , María Jesús Suárez Fernández ¹ , Martin Puchol Rizo* ¹ , Marta de Castro Liébana ¹ , Diego Burón Pérez ¹ , Antonio García Louro ¹ , Almudena de Pablo Cabrera ¹ , Daniela Ximena Rojas Correa ¹ , Beatriz Alonso Martín ¹

¹Ophthalmology,Hospital 12 de Octubre de Madrid,Madrid,Spain

Purpose

To report a clinical case of subconjunctival emphysema following a floor orbital fracture.

Setting

Ophthalmology department, Hospital 12 de Octubre, Madrid, Spain.

Methods

Clinical case report, slit-lamp images, radiology examinations and bibliographic review.

Results

A 49-year-old man presented to the emergency department after right orbital trauma as the result of a fistfight. The initial examination showed subcutaneous and lid oedema and ecchymosis. Visual acuity was 20/20, a slit-lamp examination showed subconjunctival emphysema mostly in inferior and temporal conjunctiva, being the rest of the anterior segment findings unremarkable, intraocular pressure was 10 mmHg, and there was a small area of commotio retinae in infero-temporal retina. There were no extra-ocular movements limitations, and the patient did not refer diplopia. An orbital computed tomography scan showed orbital, subconjunctival, and subcutaneous emphysema that extended to the buccal and neck spaces, associated with an orbital zygomaticomaxillary fracture. Following surgical management of the fracture by the maxillofacial surgery department, and lubricant eye drops, the patient improved, and subconjunctival emphysema and commotio retinae resolved without sequelae.

Conclusion

Subconjunctival emphysema may be an indirect sign of an underlying orbital fracture. It usually resolves itself with conservative treatment with ocular lubricants to prevent corneal dellen development and has an uneventful course. It is important to rule out orbital emphysema as it may be more threatening for the eye as it may rise intraocular pressure or cause a compressive optic neuropathy. Radiology testing such as computed tomography examination, is very useful to assess orbital trauma extension and complications.