Periorbital emphysema after a wet chamber dive

Abstract

Although periorbital emphysema (PE) is commonly associated with orbital fractures, it may develop without any fracture or significant trauma in circumstances such as post-surgery, infection, forceful nose blowing, sneezing, and weight lifting. We report on a healthy military diver who developed PE following a wet chamber dive. A diagnosis of PE secondary to sinus barotrauma was reached. He was treated conservatively without medication and his symptoms recovered completely within 10 days. To the best of our knowledge, only five cases of diving-related PE have been reported in the literature. Analysis of these cases and ours revealed that facial trauma, repeated forceful Valsalva manoeuvres and recent upper respiratory tract infection are probable risk factors for diving-related PE.

Periorbital emphysema and pneumomediastinum following blunt orbital fracture: A case report and review of the literature

“…Although the patient history and physical examination play a critical role in diagnosing periorbital emphysema and PM, imaging can also help with confirming the diagnosis and understanding the underlying mechanism. Both conventional radiography and CT scans are useful imaging modalities for detecting PM; however, the CT scan is more accurate while conventional radiography is more accessible (11,13,14).…”

“…Visual acuity, intraocular pressure, proptosis, and extraocular muscle motility must be examined; if any of these symptoms develop, immediate clinical procedures, such as orbital decompression, should occur. Additionally, patients should avoid Valsalva maneuvers that increase air pressure in sinuses and worsen the emphysema (1,4,13,17,18).…”

Case Report: Atraumatic Orbital Emphysema after Bronchoscopy with Endobronchial Biopsy

“…In addition to a traumatic bony structural defect, direct injury such as laceration to the periorbital soft tissue can introduce air into the orbit resulting in orbital emphysema. 7 It is unusual for orbital emphysema to occur without evidence of trauma; however, atraumatic orbital emphysema has been associated with forceful sneezing, nose blowing, 1 coughing, and diving 8 or as a complication after surgery 2 or dental procedure. 9 The main mechanism for orbital emphysema is the creation of an elevated pressure gradient in the body along the interconnected deep facial planes throughout the face, neck, and chest where air can travel between intra-alveolar and perivascular tissue to lower-pressure areas such as the orbital space.…”

“…Other cases of atraumatic orbital emphysema can involve sinus barotrauma where the air is accumulated in the surrounding orbital tissue because of a rapid change in barometric pressure between the intrasinusal air and the surrounding atmosphere; therefore, it is commonly observed in individuals who scuba dive. 8 There can also be an indirect spread of air through the fascial planes or a direct iatrogenic introduction of air into the orbit during or after a surgical or dental procedure. Cases of orbital emphysema have been reported as rare complications in surgical procedures such as septorhinoplasty, 2 functional endoscopic sinus surgery, 3 and retinal surgery.…”

Rhinologic and oral-maxillofacial complications from scuba diving: a systematic review with recommendations

“…As gas expands within an obstructed sinus cavity, vascular compromise leading to mucosal necrosis, and sinus wall fracture leading to pneumocephalus, periorbital/orbital emphysema and meningitis may occur. 15,36 Ischaemic neuropraxia of the maxillary branch of the trigeminal nerve within the maxillary sinus 16 and of the posterior superior branch of the alveolar nerve may also occur, leading to numbness of the ipsilateral teeth, gums, and oral mucosa. 4 It is important to ask about any previous orbital or sinus trauma, in addition to symptoms of chronic rhinosinusitis, as any blocked sinus ostia could generate a closed cavity with potential for barotrauma.…”