Delayed appearance of diplopia due to orbital emphysema after repair of orbital fractures

A 38-year-old caucasian male, after continuous nose blowing caused by common flu, developed left diplopia, especially in downward gaze, and complained of orbital dull pain during the preceding 48 hours. Clinical signs included left lower eyelid crepitant edema, mild exophthalmos and restriction of the eye movement. The patient had been operated on for orbital fractures 12 days previously. Open reduction had been performed, stabilization had been achieved with osteosynthesis miniplates, and the orbital floor defect was reconstructed with a piece of Liodura. Orbital computerized tomographic scan demonstrated a large air collection, diagnostic of emphysema, without displacement of the fractures. Under local anesthesia, aspiration-decompression was performed using a 25-gauge needle. On the next day, the patient was free of pain, and 2 days after surgery the diplopia and exophthalmos resolved with no sequelae.