ABSTRACT
OBJECTIVES: Orbital emphysema, or the presence of air in orbital tissues, is normally associated with an injury although it can arise when a Valsalva maneuver causes an increase in upper airway pressure. This potential complication of an orbital wall fracture, usually in the ethmoid bone, occurs in 50% of such cases. On fracture, air passes from the nasal fossa, sinuses, or subcutaneous tissue. The condition is benign and transient in most cases, and loss of vision is rare. No protocol for treating orbital emphysema with serious complications in which vision is affected has been established. We report 9 cases of orbital emphysema, describing events leading to the fractures, radiologic findings, and treatments.
OBJETIVO: El enfisema orbitario, presencia de aire en la órbita, se asocia normalmente a un traumatismo, aunque en ocasiones puede ocurrir de forma espontánea por una maniobra de Valsalva, con el aumento de presión en la vía aérea superior. Es una complicación potencial de las fracturas de la pared orbitaria, y se observa hasta en el 50% de ellas. Se produce por el paso de aire de las fosas nasales y/o senos nasales a la órbita o al tejido subcutáneo, y la fractura de la pared etmoidales la causa más frecuente. En la mayoría de los casos se trata de un fenómeno benigno y transitorio, que rara vez evoluciona hacia la pérdida de visión. No obstante, en los casos graves con afectación de la visión no existe un protocolo establecido de tratamiento. Presentamos nueve casos de enfisema orbitario en los que exponemos los mecanismos implicados en las fracturas, los hallazgos radiológicos y las indicaciones terapéuticas.
Subject(s)
Orbital Diseases/diagnostic imaging , Subcutaneous Emphysema/diagnostic imaging , Tomography, X-Ray Computed , Accidents, Traffic , Adult , Aged , Conservative Treatment , Facial Bones/injuries , Facial Bones/surgery , Female , Humans , Male , Middle Aged , Orbit/diagnostic imaging , Orbit/injuries , Orbital Diseases/etiology , Orbital Diseases/therapy , Orbital Fractures/complications , Sneezing , Subcutaneous Emphysema/etiology , Subcutaneous Emphysema/therapy , Vision Disorders/etiology , Wounds, Nonpenetrating/complicationsABSTRACT
El enfisema orbitario, presencia de aire en la órbita, se asocia normalmente a un traumatismo, aunque en ocasiones puede ocurrir de forma espontánea por una maniobra de Valsalva, con el aumento de presión en la vía aérea superior. Es una complicación potencial de las fracturas de la pared orbitaria, y se observa hasta en el 50% de ellas. Se produce por el paso de aire de las fosas nasales y/o senos nasales a la órbita o al tejido subcutáneo, y la fractura de la pared etmoidales la causa más frecuente. En la mayoría de los casos se trata de un fenómeno benigno y transitorio, que rara vez evoluciona hacia la pérdida de visión. No obstante, en los casos graves con afectación de la visión no existe un protocolo establecido de tratamiento. Presentamos nueve casos de enfisema orbitario en los que exponemos los mecanismos implicados en las fracturas, los hallazgos radiológicos y las indicaciones terapéuticas (AU)
Orbital emphysema, or the presence of air in orbital tissues, is normally associated with an injury although it can arise when a Valsalva maneuver causes an increase in upper airway pressure. This potential complication of an orbital wall fracture, usually in the ethmoid bone, occurs in 50% of such cases. On fracture, air passes from the nasal fossa, sinuses, or subcutaneous tissue. The condition is benign and transient in most cases, and loss of vision is rare. No protocol for treating orbital emphysema with serious complications in which vision is affected has been established. We report 9 cases of orbital emphysema, describing events leading to the fractures, radiologic findings, and treatments (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Orbital Diseases , Emphysema , Decompression, Surgical/methods , Orbital Fractures/etiology , Risk Factors , Ethmoid Bone/injuries , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To evaluate the accuracy and reproducibility of retinal thickness measurements in healthy and epiretinal membranes (ERM) eyes by Cirrus and Spectralis Fourier-domain optical coherence tomography devices. METHODS: Eighty-seven ERM and 122 healthy subjects underwent 3 macular scans using both optical coherence tomography instruments. Mean thickness measurements in the nine Early Treatment Diabetic Retinopathy Study areas were compared, evaluating the repeatability and the relationship between devices. RESULTS: Macular thickness increase was detected in ERM eyes for all optical coherence tomography parameters (P < 0.001). Mean foveal thickness was 423.5 ± 81.4 and 438.0 ± 54.2 µm for ERM eyes and 267.1 ± 20.2 and 277.5 ± 18.9 µm for healthy eyes using Cirrus and Spectralis, respectively. Macular average thickness in ERM eyes as determined by both optical coherence tomography was correlated (r = 0.812; P < 0.001) but significantly different (P = 0.044). In ERM eyes, measurements showed a mean of the coefficients of variation of 2.95%, 2.2%, and 1.01% using Cirrus, Spectralis, and Spectralis progression feature, respectively. Intraclass correlation coefficients were higher than 0.919 in all cases. CONCLUSION: Reproducibility of both Cirrus and Spectralis optical coherence tomography was high in healthy and ERM eyes. However, considerable differences were found between macular thickness measurements obtained by both devices despite the high correlation between them.
