Posttraumatic tension orbitus developed in a young man causing subconjunctival emphysema and proptosis. Intraocular pressures were monitored as a means of indirectly measuring intraorbital pressure. The patient was serially examined for evidence of compressive optic neuropathy. Because of the possibility of orbital pressure increasing several hours from the time of injury, we recommend monitoring of these patients through intraocular pressure measurement and evaluation of the optic nerve for evidence of compression. Our findings, however, do support previous documentation that the intraocular pressure rise following orbital trauma with orbital emphysema is usually not of sufficient severity or duration to result in visual compromise.