Orbital emphysema is where air collects within the eyelid or orbit, the space within the skull that contains the eyeball. This may increase pressure within the eye and result in vision loss.

The condition is somewhat rare. Trauma is the most common cause, but other factors, such as infections, may also be responsible.

While most cases require no treatment, removing the trapped air is sometimes necessary to avoid permanent vision loss.

Keep reading to learn about orbital emphysema, including its types, causes, symptoms, diagnosis, and treatments.

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Older research from 2008 notes that the types include:

  • Palpebral: This refers to cases where the air is in the eyelid only and not within the orbit.
  • Orbital: This refers to the appearance of air behind an intact orbital septum, the thin membrane that lies between the eyelid and orbit. It occurs after a fracture of the orbital bone or a tear in the mucous membrane that lines the nasal cavity.
  • Orbitalpalpebral: This occurs when pressure from air in the orbit overcomes the mechanical barrier of the orbital septum, leading to air passing from the orbit to the eyelid.

A 2019 case report explains that air in the sinuses surrounding the nose can enter the orbit through injured tissues and fractures in the orbital wall. This can disrupt orbital tissue, such as fat. After the fat shifts to allow air into the orbit, it falls backward and blocks the air’s exit. In this way, the fat or other disrupted tissue acts as a one-way valve.

The above 2019 case report suggests that trauma is the most common cause of injured tissues and fractures. However, it also explains that nontraumatic factors may be responsible. These include:

  • sneezing
  • coughing
  • nose blowing

Other nontraumatic causes include:

  • dental procedures
  • ear and throat procedures
  • infections from gas-producing microorganisms

Additionally, orbital emphysema can occur after eye surgery.

Research findings indicate that the signs and symptoms of orbital emphysema include:

  • pain in the orbit
  • restriction of eye movements
  • hypoesthesia, a reduced sensitivity to stimuli affecting the eye
  • double vision
  • proptosis, an eyeball that bulges outward
  • enophthalmos, the opposite of proptosis, which refers to an eyeball that sinks inward
  • vision loss, including blindness

Research involving 348 participants found the most common symptom is swollen eyelids with crepitus, which is a cracking sound. The second most common symptom is limited eyeball movement.

If a person experiences trauma to the eye, the diagnostic process may involve an evaluation of a person’s visual acuity and eye muscle movements. Visual acuity is the ability of the eye to recognize shapes and object details.

While reduced visual acuity is a symptom of orbital emphysema, other eye conditions can also cause it, so a correct diagnosis will involve ruling out the other possibilities. Early diagnosis of the condition is critical to prevent vision loss.

A doctor may also examine the eyelids through palpation, or touch, and order a CT scan of the orbit. A CT scan can help identify the cause underlying the condition.

Most people with orbital emphysema require no medical treatment.

According to older research from 2015, for those with typical eye movements and little or no double vision, doctors may recommend additional measures. Healthcare professionals sometimes prescribe antibiotics and nasal decongestants in cases of orbital fracture. Health experts also recommend avoiding blowing the nose for a couple of weeks.

If the emphysema progresses and is putting a person’s vision at risk, quickly removing the trapped air through direct needle drainage is necessary. This can prevent irreversible vision loss from stretching the optic nerve or compromising the blood supply. It is appropriate for individuals with increased eye pressure and:

  • restricted eye movement
  • decreased vision
  • sluggish pupil reaction

Surgery to reconstruct the orbital wall may be necessary if a person experiences:

  • double vision that is not resolving
  • a large fracture
  • a sinking eyeball of more than 2 millimeters
  • limited eyeball movements

Orbital emphysema refers to the presence of air within the tissues of the orbit or eyelid. Trauma is the most common cause, but factors unrelated to trauma, such as infections, may also cause the condition.

Symptoms may involve restriction of eye movement, double vision, proptosis, or enophthalmos. In some cases, the effects can result in permanent vision loss.

Doctors use palpation, which involves using the hands to check the area, and a CT scan to diagnose orbital emphysema.

No treatment is usually necessary, but more serious cases may require air drainage with a needle or surgical reconstruction of the orbit.

If someone has symptoms of orbital emphysema, they should seek medical attention quickly because early treatment can prevent vision loss.