Tension pneumocephalus and tension orbital emphysema following blunt trauma

Ann Emerg Med. 1996 Oct;28(4):446-9. doi: 10.1016/s0196-0644(96)70014-8.


We present the first reported case of vision loss due to tension orbital emphysema associated with tension pneumocephalus resulting from blunt trauma. In the setting of trauma, intraorbital air indicates paranasal sinus-orbital communication. Tension orbital emphysema may cause vision loss through optic nerve compression, ischemia, or contusion; or central retinal artery occlusion. Vision impairment after craniofacial injury should prompt urgent computed tomography. Tension orbital emphysema with associated vision impairment requires treatment including direct decompression and, in some cases, high-dose steroids to preserve vision. Increases in sinus pressure from coughing, nose-blowing, or vomiting should be avoided until definitive treatment can be instituted.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Craniocerebral Trauma / complications*
  • Emphysema / etiology*
  • Humans
  • Male
  • Orbital Diseases / etiology*
  • Pneumocephalus / diagnostic imaging
  • Pneumocephalus / etiology*
  • Tomography, X-Ray Computed
  • Vision Disorders / etiology*
  • Wounds, Nonpenetrating / complications*