Traumatic Orbital Emphysema Mimicking an Orbital Floor Fracture

Orbital emphysema refers to the presence of air within the orbital tissues and most commonly develops following trauma involving the paranasal sinuses or orbital walls. Although typically benign and self-limiting, it may rarely cause vision-threatening complications due to orbital compartment syndrome. The authors report a case of traumatic orbital emphysema presenting with clinical features suggestive of an orbital floor fracture. A 35-year-old man presented with left periorbital swelling and limitation of upgaze after blunt trauma. Orbital computed tomography demonstrated intraorbital air compressing the globe from the superior orbit without evidence of orbital floor fracture. The patient was managed conservatively with systemic antibiotics and intravenous methylprednisolone, resulting in complete recovery of eyelid edema and ocular motility at 1 month. This case highlights that orbital emphysema can mimic orbital floor fracture and underscores the importance of careful clinical-radiologic correlation to avoid misdiagnosis and unnecessary surgical intervention.