TENSION PNEUMOCEPHALUS AND TENSION ORBITAL EMPHYSEMA FOLLOWING BLUNT TRAUMA

We present the first reported case of vision loss due to tension orbit al emphysema associated with tension pneumocephalus resulting from blu nt trauma. In the setting of trauma, intraorbital air indicates parana sal sinus-orbital communication. Tension orbital emphysema may cause v ision loss through optic nerve compression, ischemia, or contusion; or central retinal artery occlusion. Vision impairment after craniofacia l injury should prompt urgent computed tomography. Tension orbital emp hysema with associated vision impairment requires treatment including direct decompression and, in some cases, high-dose steroids to preserv e vision. Increases in sinus pressure from coughing, nose-blowing, or vomiting should be avoided until definitive treatment can be institute d.