Orbital Emphysema Management

Assessment and Classification

Ocular motility should be assessed in patients with orbital emphysema, as part of a comprehensive evaluation of the condition 1

A short burst of oral steroids can help reduce orbital edema and hasten recovery in patients with orbital emphysema 2, 3
Immediate repair is indicated for entrapped muscle/periorbital tissue with nonresolving oculocardiac reflex in patients with orbital emphysema 2
Immediate repair is also indicated for "white-eyed blow-out fracture" with muscle entrapment, especially in children with orbital emphysema 2
Globe subluxation into the maxillary sinus is an indication for immediate repair in patients with orbital emphysema 1, 2, 3
Repair within 2 weeks is recommended for symptomatic diplopia with positive forced ductions or entrapment on CT in patients with orbital emphysema 2
Repair within 2 weeks is also recommended for large floor fractures with hypoglobus, progressive infraorbital hypoesthesia, and early enophthalmos causing facial asymmetry in patients with orbital emphysema 1, 2, 3
Conservative options, including occlusion, filters, Fresnel prisms, and prism glasses, can be used to manage persistent diplopia after resolution of emphysema 1, 3
Surgical intervention may be considered after 4-6 months to ensure stability of misalignment in patients with persistent strabismus after resolution of emphysema 1, 3

Preoperative forced generation testing and intraoperative forced duction testing are important in cases with associated strabismus and orbital emphysema 1, 3
Fat entrapment can be as challenging as extraocular muscle entrapment and may result in fibrotic adhesion syndromes in patients with orbital emphysema 1, 3