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Urgent Subconjunctival Needle Decompression for Orbital Compartment Emphysema Caused by Compressed Air Injury - 20/11/20

Doi : 10.1016/j.annemergmed.2020.06.025 
Marjan Akbari-Kamrani, MD, MPH a, , Bita Akbari-Kamrani, MD b, Mehdi Tavakoli, MD c
a 5th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Golestan, Iran 
b SARIR Academy of Research in Radiology, Gorgan, Golestan, Iran 
c Department of Ophthalmology, Callahan Eye Hospital, University of Alabama at Birmingham, Birmingham, AL 

Corresponding Author.

Abstract

Orbital compartment syndrome is a critical ophthalmic emergency that needs urgent diagnosis and treatment to prevent permanent vision loss caused by optic nerve compression or retinal ischemia. In this article, we present a child with orbital compartment syndrome caused by orbital emphysema as a result of a rare type of ocular trauma and introduce a simple technique to decompress the pressure. The patient was a 4-year-old boy who experienced a compressed air blast to his left eye. He presented to the emergency department with a frozen globe, tight orbit, and chemosis, without any evidence of globe rupture, conjunctival laceration, and orbital bone fracture. Computed tomographic scan demonstrated extensive subcutaneous, intraorbital, and intracranial emphysema. The pressure was immediately relieved under intravenous sedation by inserting a 27-gauge needle into the chemotic subconjunctival space at the lower lid fornix, followed by gentle manipulation of the globe to help the air escape through the needle. Compressed air injury is a rare type of orbital trauma, and this patient constituted the youngest case ever reported in the English literature, to our knowledge. Air decompression through the conjunctiva as described in this article is a useful technique that can be applied by emergency medicine specialists with special caution for patients with orbital compartment syndrome and orbital emphysema caused by compressed air injury.

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 Supervising editor: Jocelyn Gravel, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
 Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.


© 2020  American College of Emergency Physicians. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 76 - N° 6

P. 801-803 - dicembre 2020 Ritorno al numero
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