Diplopia is a common occurrence that results from orbital floor fracture. It can resolve, persist (improve, remain stable, or worsen), or be induced after repair of such an injury. In addition to the known myogenic cause (entrapment) of diplopia, both trauma and surgical manipulation have been shown to have the capacity to compromise ocular motor nerve function and possibly result in the development of neurogenic causes of diplopia. It has also been noted that several intraorbital adherence syndromes can potentially contribute to the development of diplopia. This is an area that requires further research.

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Subcutaneous emphysema is a relatively common finding in clinical practice. It rarely leads to fatalities. The few reported deaths in the literature have all been associated with pneumothorax. We present the case of a 61-year male who developed a fatal massive subcutaneous emphysema on a background of end stage Chronic Obstructive Pulmonary Disease with Type 2 respiratory failure. This case highlights the fact that subcutaneous emphysema can be fatal even in the absence of a pneumothorax.

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