Orbital Emphysema

Well, this week I continue my saga of family CT stories. This one is about my teenage son who wrestles and plays rugby.

This past spring he was playing in a rugby tournament and got kneed/elbowed in the eye. He said it hurt momentarily but being a 16 year old boy he didn’t think much of it and went out and finished his play (or scrum, in rugby speak…) All was well until later that evening when he came out of the shower and blew his nose. His left eye immediately swelled up like a balloon and within five minutes he was unable to open it. A late night visit to the ER earned him a head/facial bone CT and a diagnosis of…..orbital emphysema.

Orbital emphysema is usually a benign condition and is caused by air being forced into the orbital soft tissues. It is often caused by the fracture of an orbital bone, which is what happened to Aaron. When he was kneed in the eye one of the bones in his medial orbital wall fractured. He was treated in the ER with IV antibiotics to minimize the risk of any sinus bacteria infecting his eye. This was probably a good idea as he has bad allergies and frequent sinus infections. We went to an eye surgeon who reviewed his CT images and felt he would heal well without any surgery. He wasn’t able to blow his nose or use his regular steroid nasal spray (for allergies) for two weeks. He did get a sinus infection during that time which his doctor treated promptly with antibiotics. A follow-up CT two months later indicated that the area was healing and his sinuses were clear.

These CT images show a right medial wall fracture and the corresponding air in the orbital area. I wish I still had a copy of Aaron’s images – they looked remarkably like these.

Here is a great article (also source of these images):

Gauguet, J. et al. (2008). Orbital Emphysema Following Ocular Trauma and Sneezing. Radiology Case Reports, Vol 3, No 1. Accessed October 5, 2009 at http://radiologycasereports.net/index.php/rcr/article/viewArticle/124/393