Abstract
Orbital emphysema commonly occurs following traumatic orbital fractures, which usually resolve spontaneously. However, in rare cases, it can progress to tension orbital emphysema, leading to orbital compartment syndrome (OCS), a potentially blinding condition if not treated promptly. We report a 47-year-old man who developed OCS one day after sustaining blunt trauma to his right cheek. Initial examination revealed periorbital hematoma, emphysema, chemosis, and a raised intraocular pressure (IOP) of 28 mmHg without proptosis. Computed tomography showed a right orbital floor blowout fracture with orbital emphysema. His condition worsened the following day with a new onset of proptosis, total ophthalmoplegia, and an IOP of 48 mmHg. Emergency right lateral canthotomy and systemic acetazolamide reduced IOP to 28 mmHg, with full recovery after five days with 6/9 visual acuity, no relative afferent pupillary defect, resolved chemosis, normalized IOP and full range of extraocular movement. He remained stable for two weeks, after which he was lost to follow-up. This case highlights the importance of early recognition and prompt management of tension orbital emphysema to prevent permanent visual loss.