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.