Orbital barotrauma.

A 24-year-old man sustained orbital and facial injury when an industrial suction device attached to his face. Hemorrhage and edema within the orbital soft tissues were clinically evidenced by proptosis and restricted ocular motility and confirmed by computed tomography. No retinal hemorrhages or exudates were noted. Orbital soft tissue injury caused by sudden extreme decrease in extravascular atmospheric pressure (i.e., orbital barotrauma) is not well described in the ophthalmic literature. The findings in our case are remarkably similar to those seen with traumatic asphyxia and the ophthalmological hydrostatic pressure syndrome, two conditions attributed to an increase in intravascular pressure. Physiologically, our case and these conditions share a similar increase in transmural pressure at the capillary level that is responsible for fluid transudate and hemorrhage in the orbital soft tissues. Intraretinal hemorrhages and exudates typical of Purtscher's retinopathy were conspicuously absent in our patient.