Management of orbital emphysema secondary to rhegmatogenous retinal detachment repair with hyperbaric oxygen therapy

PURPOSE: To describe the case of orbital subcutaneous emphysema who was successfully treated with hyperbaric oxygen therapy. OBSERVATIONS: Case report. Retrospective analysis of medical records and computer tomography images. A 40 years-old female, with retinal detachment who was seen at the emergency department, two weeks after undergoing a combined procedure of pars plana vitrectomy, scleral buckle and Sulfur hexafluoride tamponade. The patient complained of pain, decrease eye movement and edema of the upper eyelid. Clinical examination revealed periorbital crepitus. She was treated immediately with soft tissue decompression with small-gauge needle. Orbital emphysema recurred quickly, indicating possible gas trapped in the soft tissue. Using the US NAVY decompression protocol we were able to achieve fast clinical improvement. The protocol was repeated in several occasions until complete resolution. CONCLUSION AND IMPORTANCE: Hyperbaric oxygen therapy is an effective treatment for orbital and periorbital emphysema, due to its property of helping accelerate N(2) elimination from adipose tissue.