|Year : 2019 | Volume
| Issue : 2 | Page : 184-185
Antony Arokiadass Baskaran, Latha Balasubramaniam, Tanuja Britto, Philip A Thomas
Department of Pediatric Ophthalmology, Institute of Ophthalmology, Joseph Eye Hospital, Trichy, Tamil Nadu, India
|Date of Web Publication||10-Sep-2019|
Dr. Antony Arokiadass Baskaran
Department of Pediatric Ophthalmology, Joseph Eye Hospital, Trichy - 620 001, Tami Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baskaran AA, Balasubramaniam L, Britto T, Thomas PA. Subconjunctival emphysema. TNOA J Ophthalmic Sci Res 2019;57:184-5
| Introduction|| |
A 20-year-old male presented to us with redness in the left eye (LE) following a road traffic accident. He sustained fractures of the floor and lateral wall of the left orbit. He was found to have congested temporal bulbar conjunctiva of the LE with loculations of air visible beneath the conjunctiva by slit lamp biomicroscope. The condition resolved with conservative management. His visual acuity and ocular motility remained unaffected.
| Case Report|| |
A 20-year-old male admitted to our hospital with redness in the left eye (LE) of 1-day duration. He had sustained an injury to the left side of the face following a road traffic accident the day before; he was under treatment with a neurosurgeon, who had referred the patient to us for ophthalmological evaluation. Broad spectrum oral antibiotics and analgesics had already been initiated by the treating surgeon. A computerized tomogram of the orbits and brain showed fractures of the anterior and posterolateral walls of the left maxillary sinus and the lateral wall of the left orbit. On examination, his best-corrected visual acuity was 6/6 in each eye. The anterior and posterior segments of the right eye were normal. The LE showed a congested temporal bulbar conjunctiva [Figure 1], with loculations of various sizes filled with air beneath the conjunctiva, suggestive of subconjunctival emphysema [Figure 2]. There was no conjunctival tear. The posterior segment of LE was normal. There was no proptosis or subcutaneous emphysema. There was no restriction of ocular movements, and the eyes were orthotropic in all positions of gazes. He was treated symptomatically and was sent back to the treating surgeon for further management. On review after 5 days, the emphysema was found to have completely resolved.
| Discussion|| |
Subconjunctival emphysema can occur in patients with orbital fractures due to direct passage of air from the paranasal sinuses through loose tissue planes of the orbits, into the subconjunctival space. The condition has been reported as early as 1927, following an industrial injury with an air-hose. It has also been reported following thoracic procedures resulting in extravasation of thoracic air into the subcutaneous, and later, subconjunctival planes. Rarely, it has been reported to lead to orbital emphysema in the absence of orbital fracture due to direct penetration of air through the conjunctiva and subsequently, into the orbit. It has also been reported after orbital surgeries such as abscess drainage, and decompression for thyroid orbitopathy. It has also been reported as a complication of mechanical ventilation with high positive expiratory pressure. It has been reported after assisted in situ keratomileusis (LASIK) and descemet stripping automated endothelial keratoplasty (DSAEK).
Patients with isolated subconjunctival emphysema are usually treated conservatively and just placed under observation. In a few instances, where the emphysema was severe enough to prevent lid closure, releasing the emphysema by incising the conjunctiva has been accomplished. Our patient presented with isolated subconjunctival emphysema without clinical or radiological evidence of subcutaneous or orbital emphysema, which recovered with conservative management.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ababneh OH. Orbital, subconjunctival, and subcutaneous emphysema after an orbital floor fracture. Clin Ophthalmol 2013;7:1077-9.
Ligertwood LM. Case of emphysema of the conjunctiva. Br J Ophthalmol 1927;11:233-4.
Aggarwal E, Coglan P, Madge SN, Selva D. Bilateral subconjunctival emphysema as a complication of pneumothorax. Clin Exp Ophthalmol 2011;39:581-2.
Mathew S, Vasu U, Francis F, Nazareth C. Transconjunctival orbital emphysema caused by compressed air injury: A case report. Indian J Ophthalmol 2008;56:247-9.
] [Full text]
Ide T, Kymionis GD, Goldman DA, Yoo SH, O'Brien TP. Subconjunctival gas bubble formation during LASIK flap creation using femtosecond laser. J Refract Surg 2008;24:850-1.
[Figure 1], [Figure 2]