Spontaneous compressive orbital emphysema of rhinogenic origin

We report the case of a young patient who developed spontaneous compressive
orbital emphysema after an attack of coughing. At admission the patient presented
left proptosis, diplopia, vision impairment and headache. Computer tomography
showed air in the lateral part of left orbit compressing the eyeball and the
optic nerve medially. It also revealed a sphenoid bone dysplasia with
hyperpneumatization of the left greater wing and with two dehiscences in its
wall. It was very intriguing to discover that this sphenoid dysplasia and the
flap of mucosa covering one dehiscence were causing a ball-valve effect, allowing
air to enter but not leave the orbit. Endoscopic sinus surgery was successfully
used to treat this case.