Orbital emphysema with orbital floor blow-out fracture.
He was treated conservatively and discharged with explanation of it might expected to resolve spontaneously. He was instructed to avoid blowing his nose and any other activities that may lead to increased pressure in the nasal cavity, including diving or flying.
Discussion
Cases of spontaneous orbital emphysema caused by non-traumatic reasons are very rare.1 Rapid increase in pressure in the upper airways during sneezing, coughing, nose blowing is related to barotrauma which very rarely leads to orbital wall fracture. The pressure evoked by forceful nose blowing rises to 66 mmHg, as estimated. Sneezing with the oral and nasal passages blocked may evoke a pressure up to 176 mmHg.2 Orbital emphysema without complication usually resolves spontaneously within 2 weeks.