Objective: This study was designed to describe the usual clinical findings of orbital emphysema as well as unusual and infrequent but important causes of this condition.

Design: We present seven detailed cases of orbital emphysema and review the pertinent English-language literature published since 1900.

Material and methods: Characterization of the seven patients with orbital emphysema illustrates the various causes and clinical findings of the disorder. Additionally, we review 78 previously published cases of orbital emphysema to determine the treatment and prognosis of this condition.

Results: Trauma is the most frequent cause of orbital emphysema; however, orbital emphysema also may occur spontaneously or as a complication of pulmonary barotrauma, infection, and operation. In most cases, orbital emphysema resolves spontaneously without compromising ocular function. If excessive amounts of air accumulate within the orbit, however, complications such as occlusion of the central retinal artery or compressive optic neuropathy may lead to loss of vision if not recognized promptly and treated.

Conclusion: In most cases, orbital emphysema is an incidental, benign finding that resolves with time. Careful observation is the only treatment necessary unless an orbital fracture involves an infected sinus, in which case prophylactic orally administered antibiotics may be prescribed.