Neuro-ophthalmology: Case thirteen

Figure 1

Figure 2

This 23 year-old man sustained a left black eye (figure 1) during a rugby match. There was no radiological evidence of orbital fracture. However, he developed increased swelling of his left eye whenever he blew his nose (figure 2).
a. What is the diagnosis?
Left orbital emphysema.
on palpation, subcutaneous crepitus can be felt.
b. What is responsible for this appearance?
The accumulation of air in the orbital tissues indicates a communication between the orbital tissue and one of the nasal sinuses.

The sign is most common with medial wall fracture which results in a communication with the ethmoid sinus.

c. How would you manage this patient?
It is important to exclude muscle entrapment by examining the ocular movement. Otherwise, no treatment is required except for advice against nose-blowing.

Some ophthalmologists advocate prophylactic antibiotic against orbital cellulitis.

Click here for the questions Click here for the main page Click here for MRCOphth/FRCS tutorials