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- W3093712074 abstract "An 82-year-old woman with no medical problems presented after a mechanical fall. She had no loss of consciousness, eye pain, or visual changes. There was marked echymoses, proptosis, bulbar subconjunctival emphysema (Figure 1) with medial, and lateral peri-orbital tenderness and crepitus. Extra-ocular muscles were intact with pupils equal and reactive, no afferent pupillary defect, 20/20 vision, and intra-ocular pressure of 22 mmHg. A computed tomography (CT) scan of the face showed orbital emphysema with air tracking anterior and posterior to the globe (Figure 2) with infra-orbital foramen fracture and a non-displaced inferolateral orbital wall fracture extending through the posterior maxillary sinus. The patient was discharged home after ophthalmology consultation without any subsequent visual impairment. Orbital emphysema is the accumulation of air in the orbital soft tissues most commonly after traumatic orbital fractures,1 although diverse mechanisms such as sneezing, pulmonary barotrauma, and infections have been reported.2 Optimal initial radiographic evaluation is with CT,3 which effectively identifies both air and orbital fractures. Ultrasound or magnetic resonance imaging have a limited diagnostic role but may identify globe pathology, soft tissue, or vascular injuries. Air forced into the peri-orbital spaces are trapped by the soft tissues, which act as a 1-way ball valve. Air usually accumulates superior and laterally,4 and increased intra-ocular pressures can result in vascular compromise and orbital compartment syndrome. If there is evidence of increased intra-ocular pressures, decreased vision, or afferent pupillary defect–rapid orbital decompression should be pursued. Needle decompression can be obtained by insertion of a 19-gauge needle (attached to a 10 milliliter syringe filled with 2 milliliter of 1% lidocaine) just inferior to the superior orbital rim.4 Retract the plunger until air stops returning (can visualize bubbles through the fluid) and resistance is noted." @default.
- W3093712074 created "2020-10-29" @default.
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- W3093712074 date "2020-10-19" @default.
- W3093712074 modified "2023-10-18" @default.
- W3093712074 title "Elderly woman with proptosis after head injury" @default.
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- W3093712074 doi "https://doi.org/10.1002/emp2.12303" @default.
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