Orbital fracture due to high-pressure air injection.

We present a case of orbital fracture associated with emphysema and pneumocephalus caused by a high-pressured air injection in the eyeball. A 49-year-old man injured his right eye while working with a high-pressure (compressed) air jet in a workshop. The periorbital area was swollen and ecchymotic. The bulbar conjunctiva sustained multiple lacerations around the pupil: 9 mm at 12 o'clock in direction, 6 mm at 3, 8 mm at 6, and 6 mm at 9, respectively. Computed tomography showed crisp emphysema around the right orbit, and a fracture of the medial wall of the orbit. Free air was also seen near the basal cistern and sylvian fissure, indicating a pneumocephalus. Our case proved a high pneumatic pressure could induce a fracture of the medial wall of the orbit. Green et al (Ophthal Plast Reconstr Surg 1990;6:211-217) suggested that a consistent force of more than 2.08 J is enough to inflict injury on the orbital wall.