Case Report
A 62-year-old Caucasian male with a past medical history of spontaneous
pneumothorax in 2020 and emphysematous COPD presented to the emergency
department (ED) for dyspnea. He was found to have a recurrent
pneumothorax and chest tube was placed in the ED with significant
improvement in symptoms and oxygen saturation. The patient was admitted
to the medical floor and just a few hours later, the patient became
tachypneic with moderate respiratory distress and elevated heart rate to
130-140 bpm. Oxygen saturation decreased to 85% on 2 liters of oxygen
and was increased to 15 liters via non-rebreather. The chest tube was
found to be dislodged and the patient was taken to surgery for chest
tube replacement.
A few days later, the patient developed facial and bilateral periorbital
edema. CT of the orbits revealed prominent bilateral orbital emphysema
with subcutaneous emphysema of the right upper eyelid (fig. 1), and
ophthalmology was consulted. The patient reported decreased vision in
the right eye from eyelid swelling and closure. Corrected near visual
acuity at the bedside was 20/25 (-1) OD and 20/20 OS. There was no
relative afferent pupillary defect, ocular motility was full OU, and
confrontation visual fields were full OU. Intraocular pressures were 14
mm Hg OD and 12 mm Hg OS. Examination revealed complete ptosis of the
right eye with diffuse periorbital emphysema with crepitus. Otherwise,
there was no proptosis and the anterior segment exam was normal in both
eyes. It was determined that the vision loss was purely due to the
ptosis and not from an orbital compartment syndrome. The patient was
reassured and observed throughout the course of his hospital stay. The
eyelid edema and orbital emphysema improved without vision loss, pain,
diplopia, or other signs of orbital compartment syndrome.