Orbital emphysema. Staging and acute management.

BACKGROUND

Orbital emphysema is usually a benign, transient phenomenon. Rarely, the intraorbital air mass can cause central retinal artery occlusion. Because of the potential for severe visual loss, the rapid diagnosis and management of this condition are essential. Currently, there is no standard protocol for the treatment and management of severe orbital emphysema. To develop a management algorithm, the authors reviewed the records of eight patients with orbital emphysema, in addition to nine other reported patients with ocular dysfunction.

METHODS

Retrospective review of patients with orbital emphysema who have proptosis, diplopia, or loss of vision.

RESULTS

Orbital emphysema is associated with small orbital fractures. The location of the intraorbital air mass usually correlates with the fracture location. A four-stage classification system of orbital emphysema is developed. This staging system is helpful in constructing an acute diagnostic and management algorithm for orbital emphysema.

CONCLUSION

Understanding the pathophysiology of orbital emphysema is important in developing a rational approach to manage this potentially sight-threatening condition. Treatment using a needle-coupled open syringe filled with saline allows direct monitoring of the air mass during decompression.