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Orbital emphysema, also called pneumo-orbit, is a condition that occurs when air becomes trapped in your eye socket. It can lead to symptoms such as swelling or bruising around your eye, vision problems, and eye bulging. The most common cause is blunt trauma.

Most cases of orbital emphysema resolve by themselves within a couple of weeks, but prompt medical attention is critical to avoid potential complications that can cause permanent vision loss. Severe cases may need surgery to relieve pressure in your eye socket.

Read on to learn more about orbital emphysema, including its causes and treatment, and the outlook for people with the condition.

Your eyeballs are surrounded by a spherical arrangement of delicate bone called your orbit, or more familiarly, your eye socket. Your eye socket also contains other structures such as muscles, fat, and blood vessels.

Orbital emphysema occurs when air gets trapped in your orbit. It’s a fairly rare condition that’s most commonly caused by trauma. Depending on the underlying cause and where the air is trapped, you can develop symptoms such as:

The types and stages of orbital emphysema

There are three types of orbital emphysema:

  • Palpebral emphysema. Trapped air gathers under your eyelid. It’s often associated with fractures of your lacrimal bone.
  • True orbital emphysema. A fracture of the bony wall of your orbit allows air to enter from your sinuses and become trapped.
  • Orbitopalpebral emphysema. Trapped air develops both under your eyelid and in your orbit.

Regardless of the specific type of orbital emphysema, it has four different stages.

Stages of orbital emphysema

Orbital emphysema is divided into four stages:

  • Stage 1. Only a small amount of air is trapped in your orbit. It may be visible with imaging, but it doesn’t cause any symptoms.
  • Stage 2. Trapped air displaces your eyeball from its usual position and may lead to bulging or double vision.
  • Stage 3. Trapped air increases pressure in your eyeball and the optic nerve, which may cause vision loss.
  • Stage 4. Significantly raised pressure from trapped air blocks blood flow to the eyeball and can lead to permanent vision loss.
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In a 2019 study, researchers found that blunt trauma to the eye was the most common cause of orbital emphysema but that 25 other potential causes have been reported in the medical literature.

The typical way blunt trauma leads to orbital emphysema is by fracturing the bone that separates your sinuses from the inner part of your eye socket. Up to 75 percent of people who fracture this part of their orbit have some degree of orbital emphysema.

Air can pass through your sinus through the fracture and fragments of fat and other tissues around the fracture can effectively create a one-way valve that traps it.

A rapid increase in pressure in your sinuses from sneezing or blowing your nose shortly after the fracture can potentially introduce air into your eye socket.

Unusual causes of orbital emphysema

Orbital emphysema can have many potential causes, but some causes are very rare and have only been reported once or a handful of times in medical literature. Here are some examples.

A 2019 case study reported a 43-year-old woman who developed orbital emphysema following functional endoscopic sinus surgery.

A 2020 case study reported a 42-year-old man with COVID-19-related respiratory distress syndrome who was on a mechanical ventilator and developed orbital emphysema after air migrated from a rupture in his lungs.

Although rare, it’s possible to develop orbital emphysema from blowing your nose. It’s most likely to occur if you forcefully blow your nose shortly after fracturing the inner part of your eye socket.

Only a handful of case studies report people developing orbital emphysema from nose blowing without a history of facial trauma. Here are three examples.

  • A 2019 case study reported a 59-year-old woman with chronic rhinitis, or sinus inflammation, who developed orbital emphysema and orbital fracture after forceful nose blowing.
  • A 2020 case study reported a 76-year-old man who developed orbital emphysema without a history of facial trauma. Imaging revealed an orbital wall fracture suspected to be caused by nose blowing.
  • A 2017 case study reported a case of a 33-year-old man with no history of head injury who developed orbital emphysema and orbital fracture after vigorous nose blowing.

Mild cases of orbital emphysema usually resolve within 7 to 10 days and don’t cause long-term eye damage. However, prompt medical attention is necessary to monitor whether treatment is needed to alleviate eye pressure.

Severe cases can lead to two conditions that can cause permanent vision loss called retinal artery occlusion or optic nerve ischemia.

Retinal artery occlusion is a blockage in blood flow to your retina. Your retina is the part of your eye that converts light into electrical activity. Optic nerve ischemia is a loss of blood flow to the nerve that connects your eye to your brain.

As of February 2019, only four cases of significant vision loss following orbital emphysema have been documented in the medical literature.

Mild cases of orbital emphysemacan be treated with observation alone. More severe cases may require surgery or needle aspiration to relieve pressure on your eyeball, blood vessels, or optic nerve.

Antibiotics are generally recommended for people with an orbital fracture that extends into the sinuses to prevent infection.

Orbital emphysema is a condition caused by trapped air in your eye socket. Most cases resolve within a couple of weeks on their own without clinical treatment, but it’s important to visit a doctor as soon as possible to monitor for complications that may cause permanent vision loss.

Symptoms can vary based on the underlying cause but can include bulging of your eye, swelling around your eye, and pain.