A case report and systematic review of periorbital emphysema following nose blowing or sneezing.

Abstract

Periorbital emphysema following nose blowing or sneezing is rare. Although it is often self-limiting, air trapping in the orbit can raise the intraocular pressure leading to visual complications. At present, the literature on this topic is confined to case reports. In this article, we present a rare case of periorbital emphysema following nose blowing in a 34-year-old woman and a subsequent systematic review that included 43 case reports of periorbital emphysema following similar mechanisms. Orbital wall fracture was seen in 70% and a defect in the lamina papyracea is the most common finding on computed tomography imaging. Surgical intervention was performed in 30% of patients; indications included visual compromise, paranasal osteoma and inflammatory disease. Most patients can be safely discharged on the same day with oral antibiotics unless there are clinical signs of visual compromise or sinonasal mass that may necessitate surgical intervention. The recurrence rate is low (3%) and almost all will resolve within 4 weeks.