ORBITAL EMPHYSEMA - STAGING AND ACUTE MANAGEMENT

Background: Orbital emphysema is usually a benign, transient phenomeno n. Rarely, the intraorbital air mass can cause central retinal artery occlusion. Because of the potential for severe visual loss, the rapid diagnosis and management of this condition are essential. Currently, t here is no standard protocol for the treatment and management of sever e orbital emphysema. To develop a management algorithm, the authors re viewed the records of eight patients with orbital emphysema, in additi on to nine other reported patients with ocular dysfunction. Methods: R etrospective review of patients with orbital emphysema who have propto sis, diplopia, or loss of vision. Results: Orbital emphysema is associ ated with small orbital fractures. The location of the intraorbital ai r mass usually correlates with the fracture location. A four-stage cla ssification system of orbital emphysema is developed. This staging sys tem is helpful in constructing an acute diagnostic and management algo rithm for orbital emphysema. Conclusion: Understanding the pathophysio logy of orbital emphysema is important in developing a rational approa ch to manage this potentially sight-threatening condition. Treatment u sing a needle-coupled open syringe filled with saline allows direct mo nitoring of the air mass during decompression.