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Needle decompression of acute orbital emphysema: case report with video
  1. Garrick Chak,
  2. Jeffrey M Joseph,
  3. Jeremiah P Tao
  1. Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, California, USA
  1. Correspondence to Dr Garrick Chak, Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, 118 Med Surge 1, Irvine, CA 92697-4375, USA; chakg{at}

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Orbital emphysema is caused by a communication of air from the paranasal sinuses into the orbit along a pressure gradient. Small orbital fractures may form a one-way valve that allows air inflow and prohibits air outflow, causing progressively increasing intraorbital pressure that leads to an acute orbital compartment syndrome. This presentation is also known as progressive orbital emphysema.1 Differentiating benign orbital emphysema from progressive orbital emphysema is critical because benign orbital emphysema, without compartment syndrome, spontaneously regresses without adverse sequelae. Progressive emphysema, however, often requires urgent decompression of the trapped air and acute orbital compartment syndrome. Irreversible vision loss may ensue due to vascular compromise or mechanical stretching of the optic nerve. We describe a case and—for the first time to the authors’ knowledge—provide video documentation of successful bedside needle decompression of the orbit.


A 51-year-old Hispanic man presented with acute right eye pain and diplopia. He had experienced blunt trauma to the right side of his face hours before presentation. The eye pain worsened acutely after blowing his nose hours after injury. In addition, he developed nausea and felt heavy ‘pressure’ upon the right eye. The patient had a 3-year history of poorly controlled diabetes mellitus but was otherwise healthy with no ophthalmic history.

On examination, pinhole visual acuity was 20/60 in the right eye and 20/20 in the left …

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  • Contributors GC is credited with primary authorship, acquisition of supplemental digital media, final approval. JMJ is credited with insightful analysis and interpretation of case, detailed constructive revision, final approval. JPT is credited with design of procedure, intellectual revision, final approval.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This manuscript is an educational case report and not a clinical trial, thus institutional review board approval is not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • ▸ Videos are available online only. To view these files please visit the journal online (