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.


CONCLUSIONS
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.
Hunts
J H
JH
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030.
Patrinely
J R
JR
Holds
J B
JB
Anderson
R L
RL
D000328:Adult; D004172:Diplopia / Q000209:etiology; D004646:Emphysema / Q000145:classification* / Q000209:etiology / Q000628:therapy*; D005094:Exophthalmos / Q000209:etiology; D005131:Eye Injuries / Q000150:complications; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000145:classification* / Q000209:etiology / Q000628:therapy*; D009917:Orbital Fractures / Q000209:etiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity