High-Pressure Air Injury of the Orbita and the Neurocranium in the Absence of a Severe External Trauma

A 43-year-old male subject without neurological deficits presented left eye ptosis and diplopia caused by subcutaneous emphysema after high-pressure (2.2 MPa) air injury. Ophthalmologic examination disclosed bilateral subconjunctival air, with no visible conjunctival lacerations. The computed tomography presented an orbital emphysema, a fracture of the orbital floor and intracranial air particularly periclival and pre-chiasmal. Visus stayed at a constant good level. After 36 hours, both intracranial air and intraorbital emphysema were markedly reduced without surgical intervention. However, detailed ophthalmological examination showed binasal deficit in the visual field. Orbital emphysema due to high-pressure air injury has rarely been reported in literature.