Orbital, subconjunctival, and subcutaneous emphysema after an orbital floor fracture

A 16-year-old boy presented to the emergency department with the complaint of a sudden, painful left eye and proptosis after an episode of sneezing. A few hours earlier, he had sustained a blunt trauma to the left orbit as the result of a fistfight. The initial-examination showed subcutaneous and subconjunctival emphysema. Visual acuity in the left eye was 20/30 (0.67), the pupils were reactive with no relative afferent pupillary defect, and there were mild limitations in levoduction and supraduction. A slit-lamp examination showed normal anterior and posterior segments with an intraocular pressure of 26 mmHg. An orbital computed tomography scan showed orbital, subconjunctival, and subcutaneous emphysema associated with a small fracture of the orbital floor. Following conservative management with broad-spectrum oral antibiotics, a topical antiglaucoma drug, and lubricating eye drops, the patient improved - dramatically within one week.