Orbital emphysema as a result of chest tube placement for recurrent pneumothorax

Orbital emphysema refers to the presence of air or gas within the orbital soft tissue space. Although orbital fracture due to trauma is the most common cause, iatrogenic orbital emphysema from chest tube insertion is a rare but potentially serious complication from the treatment of pneumothorax. Symptoms can range from mild crepitus of the periorbital region to permanent vision loss secondary to central retinal artery occlusion or optic neuropathy, a result of orbital compartment syndrome. Management is dependent on the presence of orbital signs and vision loss. Herein, we present a rare case of orbital emphysema in the setting of pneumothorax and chest tube insertion in a 62 year-old patient admitted to the hospital floor. Presenting symptoms included vision loss and bilateral orbital edema, while physical exam revealed complete ptosis of the right eye with diffuse periorbital emphysema and crepitus. Diagnosis was confirmed clinically and with CT head and orbits. The patient's vision loss was felt to be secondary to ptosis; thus, interventions were not necessary and his condition resolved with observation. The present case and associated literature review highlights orbital emphysema as a complication of chest tube insertion and pneumothorax, as well as the drastic complications of the condition if left untreated.