Orbital emphysema with loss of vision following undiluted intravitrel perfluoropropane administration

Abstract

We present a case of orbital emphysema leading to orbital compartment syndrome and permanent visual loss secondary to expansion of perfluoropropane (C3F8) gas, which was injected into the vitreous cavity as a gaseous tamponade during vitreoretinal surgery and inadvertently undiluted. Orbital emphysema leading to orbital compartment syndrome resulted in visual loss despite treatment with lateral canthotomy, cantholysis and surgical decompression. Orbital compartment syndrome is an ophthalmic emergency and should be treated immediately with lateral canthotomy and cantholysis. There is little literature on the management and outcomes of orbital compartment syndrome with expansile gases such as C3F8 which may quadruple in volume within 96 hours. Hyperbaric oxygen has been reported to be of benefit but patients may require orbital decompression for definitive treatment. Although orbital emphysema with air rarely threatens vision orbital emphysema with expansile gases can lead to orbital compartment syndrome and visual loss.