April 2010
Volume 51, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2010
Orbital Emphysema and Ocular Surgery: A Retrospective Analysis and New Etiology
Author Affiliations & Notes
  • B. Ahmad
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio
  • R. Singh
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio
  • M. Barakat
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio
  • Footnotes
    Commercial Relationships  B. Ahmad, None; R. Singh, None; M. Barakat, None.
  • Footnotes
    Support  Unrestricted Grant from Research to Prevent Blindness
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 5374. doi:
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      B. Ahmad, R. Singh, M. Barakat; Orbital Emphysema and Ocular Surgery: A Retrospective Analysis and New Etiology. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5374.

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Abstract

Purpose: : To study the prevalence and mechanisms of orbital emphysema as a complication of ocular surgeries, and propose it as a previously undescribed complication of vitrectomy.

Methods: : A PubMed database search was utilized to find human clinical cases of orbital and subcutaneous peri-orbital emphysema when associated with ocular surgical procedures. Additionally, cases meeting these criteria from Cole Eye Institute (Cleveland, OH) were examined for inclusion within the study.

Results: : Using the Pubmed search criteria, a total of 4 manuscripts were identified that met the criteria (6 patients). Orbital emphysema, when associated with ocular surgery, was found in oculoplastic cases; cases were reported in orbital decompression (3 cases), orbital fracture repair (2 cases), and upper eyelid reconstruction (1 case). An additional and previously undescribed etiology, that of orbital emphysema in the setting of vitrectomy (1 case), is also reported from our institation.

Conclusions: : Emphysema occurs following forceful injection of gas or liquid into orbital soft tissue. While trauma is the overwhelming etiology of such injury, surgical complications (particularly in ENT cases), and other rare causes can also lead to this outcome.We find that it is rare in ocular surgery, but when present it is associated with oculoplastic procedures and generally as the result of communication with sinus cavities.We report vitrectomy as a new etiology, when done in the presence of an undetected globe perforation and continuous infusion. Our proposed mechanism is the transfer of liquid and gas through the infusion port to maintain target intraocular pressure in the presence of a perforation allowing extraocular release.

Keywords: orbit • vitreoretinal surgery 
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