Cutting S, Davies-Husband C, Poitelea C
East Kent University Hospitals NHS Trust, UK.
Brighton and Sussex University Hospitals NHS Trust, UK.
Case Rep Ophthalmol Med. 2021 Mar 11;2021:8884009. doi: 10.1155/2021/8884009. eCollection 2021.
The majority of cases of orbital emphysema are due to trauma. Complications are rare, and therefore, the need for surgical intervention is uncommon. We present the first case of which we are aware in which nontraumatic orbital emphysema led to orbital compartment syndrome and subsequent optic nerve dysfunction. The patient underwent emergency needle decompression. A 51-year-old man presented to the Emergency Department with right-sided unilateral proptosis, reduced visual acuity, and binocular diplopia. This occurred after performing a Valsalva manoeuvre with no history of head trauma. He also mentioned that over the past year he had experienced multiple episodes of transient proptosis occurring after Valsalva manoeuvres. Visual acuity in the right eye was reduced to 6/21. A relative afferent pupillary defect was present and intraocular pressure (IOP) was 12 mmHg. The CT scan showed significant orbital emphysema in the medial aspect of the right orbit. Needle decompression was performed resulting in immediate resolution of his symptoms. This case demonstrates that, in cases of orbital emphysema, a lack of a history of trauma and a normal IOP cannot always be used to rule out serious pathology.
大多数眼眶气肿病例是由外伤引起的。并发症很少见，因此，手术干预的必要性并不常见。我们报告了首例我们所知的非创伤性眼眶气肿导致眼眶间隔综合征及随后视神经功能障碍的病例。该患者接受了紧急穿刺减压。一名51岁男性因右侧单侧眼球突出、视力下降和双眼复视就诊于急诊科。这是在进行瓦尔萨尔瓦动作后发生的，无头部外伤史。他还提到，在过去一年里，他在进行瓦尔萨尔瓦动作后经历了多次短暂性眼球突出发作。右眼视力降至6/21。存在相对传入性瞳孔障碍，眼压（IOP）为12 mmHg。CT扫描显示右侧眼眶内侧有明显的眼眶气肿。进行了穿刺减压，其症状立即得到缓解。该病例表明，在眼眶气肿病例中，缺乏外伤史和正常眼压并不总是能用来排除严重病变。
