Spontaneous orbital emphysema in a pediatric patient
What:
Paper Presentation | Présentation d'article
Part of:
When:
2:14 PM, Friday 1 Jun 2018
(6 minutes)
Where:
Metro Toronto Convention Centre (South Building)
- Room 714 A
How:
Authors: Georges B. Nassrallah, Vincent Sun, Ayesha Khan
Author Disclosure Block: G.B. Nassrallah: None. V. Sun: None. A. Khan: None.
Abstract Body:
Purpose: Spontaneous orbital emphysema in the absence of recent trauma is exceedingly rare, with less than 5 cases reported in the literature. It has been hypothesized that a congenitally thinner lamina papyracea, chronic sinusitis, previous minor trauma or previous nasal surgery may predispose to this condition. In rare cases, orbital emphysema may lead to ischemic optic neuropathy or central retinal artery occlusion. We report the first case in the literature of spontaneous orbital emphysema in a pediatric patient.
Study Design: Case report.
Methods: The patient’s medical chart was reviewed and a comprehensive literature review was conducted.
Results: An 11-year-old female presented to ophthalmology clinic with a 3-day history of right periorbital swelling that started spontaneously when she blew her nose and heard a pop. She had no known previous medical or surgical history and there was no recent history of infection or significant trauma. On exam, her vision was 20/20 in both eyes and her pupils were equal and reactive to light with no relative afferent defect. She had mild restriction in right supraduction. Exophthalmometry measurements were 23 OD, 21 OS and a base of 100. Her upper lid was swollen with crepitus on palpation, but anterior and fundus exams were unremarkable. Computed Tomography of her orbits and facial bones revealed loculated air superiorly and laterally within the right bony orbit communicating with the ethmoid sinus as well as medial deviation of the lateral ethmoid sinus wall. These findings were suggestive of remote trauma or a developmental anomaly. The patient was followed closely and the emphysema resolved with abstinence from nose blowing and a short prophylactic course of antibiotics.
Conclusions: This is the first report of spontaneous orbital emphysema in the pediatric population. A history of increased pressure in the nasal cavity immediately preceding symptoms either by nose blowing or sneezing is vital in making the correct diagnosis and arranging prompt referral to ophthalmology in order to rule out unlikely, but possibly devastating complications.
Author Disclosure Block: G.B. Nassrallah: None. V. Sun: None. A. Khan: None.
Abstract Body:
Purpose: Spontaneous orbital emphysema in the absence of recent trauma is exceedingly rare, with less than 5 cases reported in the literature. It has been hypothesized that a congenitally thinner lamina papyracea, chronic sinusitis, previous minor trauma or previous nasal surgery may predispose to this condition. In rare cases, orbital emphysema may lead to ischemic optic neuropathy or central retinal artery occlusion. We report the first case in the literature of spontaneous orbital emphysema in a pediatric patient.
Study Design: Case report.
Methods: The patient’s medical chart was reviewed and a comprehensive literature review was conducted.
Results: An 11-year-old female presented to ophthalmology clinic with a 3-day history of right periorbital swelling that started spontaneously when she blew her nose and heard a pop. She had no known previous medical or surgical history and there was no recent history of infection or significant trauma. On exam, her vision was 20/20 in both eyes and her pupils were equal and reactive to light with no relative afferent defect. She had mild restriction in right supraduction. Exophthalmometry measurements were 23 OD, 21 OS and a base of 100. Her upper lid was swollen with crepitus on palpation, but anterior and fundus exams were unremarkable. Computed Tomography of her orbits and facial bones revealed loculated air superiorly and laterally within the right bony orbit communicating with the ethmoid sinus as well as medial deviation of the lateral ethmoid sinus wall. These findings were suggestive of remote trauma or a developmental anomaly. The patient was followed closely and the emphysema resolved with abstinence from nose blowing and a short prophylactic course of antibiotics.
Conclusions: This is the first report of spontaneous orbital emphysema in the pediatric population. A history of increased pressure in the nasal cavity immediately preceding symptoms either by nose blowing or sneezing is vital in making the correct diagnosis and arranging prompt referral to ophthalmology in order to rule out unlikely, but possibly devastating complications.
