Orbital emphysema refers to the infiltration of air or gas within the orbital soft tissue space. It is most commonly associated with a history of trauma or orbital wall fracture. [1][2][3] However, other mechanisms have been reported including infection, pulmonary barotrauma, and iatrogenic factors such as dental surgery. 4 Signs and symptoms include proptosis, crepitus, and diplopia presenting acutely or over the course of days to weeks. 5,6 Although orbital emphysema typically follows a benign course and is self-limiting, in severe cases, it can cause vision loss and require immediate intervention to prevent complications associated with orbital compartment syndrome. 2,7 Herein, we present a case report of bilateral orbital emphysema in a single individual after chest tube placement for spontaneous pneumothorax. This case illustrates the potential for dramatic complications of such a procedure