Orbital emphysema following orbital cholesterol granuloma surgery

A 50-year-old male presented with complaints of gradually progressive prominence of the left eye associated with a diminution of vision. Magnetic resonance imaging showed a well-circumscribed extraconal mass arising from the intradiploic space with erosion and thinning of the orbital roof. Excision and complete curettage were performed. On the 11 th postoperative day, the patient presented with gross proptosis, ballooning of the conjunctiva, and exposure keratopathy following forceful nose blowing. An urgent computed tomography scan revealed an orbital emphysema, and a needle orbital decompression was performed. The patient improved clinically and radiologically with nil recurrence at follow-up. Orbital emphysema post-surgery, though rare, should be considered as a differential of acute-onset postoperative proptosis. Patients should be advised to avoid forceful blowing of nose or any Valsalva maneuver to prevent such a complication.