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| CLINICAL IMAGE |
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| Year : 2022 | Volume
: 15
| Issue : 1 | Page : 113-114 |
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Gas bubble in anterior chamber with orbital emphysema following blunt trauma: A novel presentation
Jyoti Shakrawal, Karthikeyan Mahalingam, Ayushi Sinha
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| Date of Submission | 16-Apr-2021 |
| Date of Acceptance | 21-Oct-2021 |
| Date of Web Publication | 02-Mar-2022 |
Correspondence Address:
Dr. Karthikeyan Mahalingam
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ojo.ojo_120_21
Keywords: Anterior chamber, gas bubble, orbital emphysema
How to cite this article:
Shakrawal J, Mahalingam K, Sinha A. Gas bubble in anterior chamber with orbital emphysema following blunt trauma: A novel presentation. Oman J Ophthalmol 2022;15:113-4 |
How to cite this URL:
Shakrawal J, Mahalingam K, Sinha A. Gas bubble in anterior chamber with orbital emphysema following blunt trauma: A novel presentation. Oman J Ophthalmol [serial online] 2022 [cited 2022 May 19];15:113-4. Available from: https://www.ojoonline.org/text.asp?2022/15/1/113/338869 |
Globe injury either open or closed leads to air entry in the eye. Air in the anterior chamber warrants an open globe injury, whereas closed globe injury may lead to orbital emphysema after orbital wall fractures. Atmospheric air inside the eye, whether in the anterior chamber or the orbit needs early and vigilant care. We report the first case of a gas bubble in the anterior chamber along with orbital emphysema following blunt trauma.
A47-year-old male presented to the emergency department with a complaint of a decrease in vision in the right eye (RE) since morning following blunt trauma with a fist. On examination, visual acuity was 1/60; intraocular pressure was 6 mmHg in RE. A linear corneal perforation of about 3 mm was present in the center of the cornea. Pressure Seidel's test was positive. The anterior chamber was deep due to the presence of two air bubbles in the anterior chamber [Figure 1]a. The patient was pseudophakic with a stable Intraocular lens (IOL)-bag complex. X-ray orbit did not reveal any orbital fracture. RE corneal perforation repair by a single 10.0 MFN with anterior chamber wash and intracameral antibiotic[1] was done on an emergency basis on the same day. The next morning, the patient developed, periorbital swelling, proptosis, and restriction of extraocular movements [Figure 1]b. The vision was 6/36 in RE. Ocular ultrasonography was anechoic. On suspicion of orbital cellulitis,[2] intravenous antibiotics were started, and a noncontrast computed tomography (CT) was advised. The CT [Figure 1]c revealed a medial orbital wall fracture and orbital emphysema. Surgical drainage was done with a 24G needle under CT guidance with aseptic precautions. The signs of proptosis and extraocular movement improved immediately [Figure 1]d. Visual acuity at 4 weeks postoperative after suture removal was 6/9 with-1DS/-2DCX1700 in RE. | Figure 1: (a) Image showing air bubble in anterior chamber with self-sealed corneal perforation (white arrow). (b) Periorbital swelling, proptosis following corneal perforation repair (white arrow). (c) Noncontrast computed tomography image showing medial orbital wall fracture and orbital emphysema (red arrow). (d) Reduction in proptosis following computed tomography-guided surgical drainage
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The presence of a gas bubble in the anterior chamber following trauma is rare and is suggestive of open globe injury.[3] Orbital emphysema along with anterior chamber gas bubble following a blunt trauma has not been reported to date in the literature. After orbital wall fracture, air from the frontal or ethmoid sinus enters into orbital tissue.[4] It can also occur with a lag time until the patient coughs or sneezes.[5] In our case, the orbital emphysema occurred 1 day after trauma. Orbital emphysema can resolve on its own without treatment due to absorption of air. A prophylactic antibiotic course should be given till that time. In case of orbital compression, decompression must be done on an emergency basis either by needle aspiration or canthotomy.[5] Although CT-guided orbital decompression can be done before the signs of the central retinal artery or optic nerve compression appears, as we did in our case. Repair of the fractured wall can be carried out at a later date. Therefore, even in a case of fist injury, a CT scan of the orbit should be done as a primary workup as, fist injury, in the form of blunt injury, is one of the most common causes of orbital wall fractures.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Thevi T, Abas AL. Role of intravitreal/intracameral antibiotics to prevent traumatic endophthalmitis-Meta-analysis. Indian J Ophthalmol 2017;65:920-5.  [ PUBMED] [Full text] |
| 2. | Lee S, Yen MT. Management of preseptal and orbital cellulitis. Saudi J Ophthalmol 2011;25:21-9. |
| 3. | Barnard EB, Baxter D, Blanch R. Anterior chamber gas bubbles in open globe injury. J R Nav Med Serv 2013;99:53-4. |
| 4. | Zimmer-Galler IE, Bartley GB. Orbital emphysema: Case reports and review of the literature. Mayo Clin Proc 1994;69:115-21. |
| 5. | Gauguet JM, Lindquist PA, Shaffer K. Orbital emphysema following ocular trauma and sneezing. Radiol Case Rep 2015;3:124. |
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