Spontaneous Orbital Subcutaneous Emphysema Case Report

Spontaneous orbital emphysema is defined as the presence of air within the orbital tissues in the absence of direct trauma, typically associated with a sudden increase in intranasal pressure during maneuvers such as nose blowing, sneezing, or performing a Valsalva maneuver. This abrupt rise in pressure may cause microfractures or open preexisting anatomical dehiscences in the lamina papyracea or the medial orbital wall, allowing air to pass into the extraconal spaces. Although its presentation is often sudden and alarming—characterized by periorbital edema, subcutaneous crepitus, and marked aesthetic changes—it is usually a benign and self-limited condition when recognized in a timely manner. We present the case of a 43-year-old woman who consulted for sudden edema and crepitus of the right eyelid immediately after blowing her nose. The initial examination revealed significant bilateral eyelid edema limiting ocular opening, accompanied by crepitus without severe pain, no signs of infection, and no visual impairment. Given the initial suspicion of periorbital cellulitis, the patient was managed under observation until diagnostic imaging was obtained Computed tomography of the paranasal sinuses confirmed the presence of extraconal orbital emphysema without major fractures or signs of infection, a finding that allowed avoidance of unnecessary antibiotic use and invasive procedures. The literature supports this pathophysiological mechanism, highlighting increased intranasal pressure as a frequent trigger of spontaneous orbital emphysema. Experience with this type of case and its early recognition make it possible to differentiate it from infectious processes, optimize conservative management, and reduce unnecessary interventions, thereby contributing to the strengthening of clinical knowledge in emergency care settings.