Unilateral Orbital Emphysema Secondary to Vitreoretinal Surgery

Ophthalmol Retina. 2020 Jul;4(7):708-719. doi: 10.1016/j.oret.2020.01.008. Epub 2020 Jan 13.


Purpose: To describe preoperative, intraoperative, and postoperative characteristics, imaging findings, and clinical evolution of patients who developed orbital emphysema after vitreoretinal surgery.

Design: Retrospective, descriptive, observational case series.

Participants: Patients with orbital emphysema after vitreoretinal surgery who were diagnosed and treated between January 2006 and October 2018 at a single ophthalmology referral center.

Methods: Medical records and orbital computed tomography images were reviewed and analyzed. A minimum follow-up of 3 months was required.

Main outcome measures: Final best-corrected visual acuity (BCVA).

Results: This study included 16 patients with a mean age of 47.9 ± 14.7 years, 50% were women, and 25% had a history of previous ocular trauma. A diagnosis of rhegmatogenous retinal detachment was established in 75% of patients. Twenty-five percent of patients underwent pars plana vitrectomy (PPV), 50% underwent encircling scleral buckling plus PPV, 18.8% underwent repeat PPV, and 6.2% underwent scleral buckling plus repeat PPV. Additionally, 62.5% received silicone oil endotamponade. The median time between vitreoretinal surgery and orbital emphysema was 8 days (interquartile range [IQR] 5-15 days). Mean proptosis was 6.7 ± 4.6 mm. Orbital cellulitis was considered as a differential diagnosis in 31.2% of patients, and tomographic evidence of fracture was observed in 25% of patients. Treatment with compressive patching was prescribed for 87.5% of patients, transpalpebral drainage was prescribed for 75% of patients, hyperbaric oxygen therapy was prescribed for 43.8% of patients, and surgical management was prescribed for 31.2% of patients. The comparison between BCVA before vitreoretinal surgery (median, 1.8 logarithm of the minimum angle of resolution [logMAR]; IQR, 1.33-2.3 logMAR) and at the last follow-up (median, 2.3 logMAR; IQR, 1.42-2.8 logMAR) was not statistically significant (P = 0.125, Wilcoxon matched-pairs signed-rank test). No association was found between surgeon experience and lower final BCVA (P = 0.604, Fisher exact test); however, development of ocular hypertension was associated with worse final BCVA (P = 0.0101; relative risk, 7; 95% confidence interval, 1.01-44.63).

Conclusions: Although orbital emphysema constitutes a very unusual complication of vitreoretinal surgery, it is important to identify this condition promptly and treat patients efficiently to avoid potential vision loss.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Emphysema / diagnosis
  • Emphysema / etiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Orbital Diseases / diagnosis
  • Orbital Diseases / etiology*
  • Postoperative Complications*
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Visual Acuity*
  • Vitreoretinal Surgery / adverse effects*