Case 4: Swollen orbit
Tuesday, January 11th, 2011This 34-year-old patient has had a ‘cold’ for three days. She developed a sudden sharp pain around her left eye yesterday immediately after blowing her nose. She has presented today with mild discomfort and swelling around the left eye, which she cannot open.
1. What is the likely diagnosis?
Click to see the answerThis is orbital emphysema, a well recognized complication of forceful sneezing and nose-blowing. High-pressure within an ethmoid sinus causes rupture of the fragile bone separating the sinus from the orbit, and leakage of air into the orbit.
2. What clinical sign is diagnostic?
Click to see the answerSurgical emphysema can usually be palpated over the orbit.
3. How can the diagnosis be confirmed?
Click to see the answerFacial views will often show free air within the orbit. This may be seen to outline the globe. (See figure)
(Patient’s AP facial view x-ray, showing air within the left orbit)