Swollen Eyelids after Nose Blowing | Best Way to Diagnose

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Nose-blowing is a process of expelling nasal mucus by exhaling forcefully through the nose. Usually, it is processed into a handkerchief or facial tissue, handkerchiefs are softer while facial tissues being more hygienic as they are disposed of after each use more stylish environmentally friendly.

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To breathe forcefully with expel mucus into the tissue by the nose. usually, allergies are so bad that you may have to blow your nose constantly just to be able to breathe.

A Case Presentation of Swollen Eyelids after Blowing Nose

Today I am sharing with you a case of swollen eyelids after nose blowing. A 60 years old man experienced a nose blockage and he suffered with an unexpected right eyelid swelling with diplopia when blowing one nostril while blocking the other with her finger. His medical and family history was unremarkable except for chronic seasonal sinusitis. He refused to accept a history of alcohol consumption, smoking, and previous rhinosinusal surgery and facial trauma.

During the examination, the patient had ecchymosis and painful swelling of the right eyelid with a couple of restricted ocular movements of the affected eye. Palpation showed crepitus over the right eyelid with no proof of sensory abnormality.

He was diplopic in upgaze. Visual acuity was normal bilaterally but the right visual field was decreased due to marked palpebral swelling. Pupils of the eyes were equal and reactive to light with no afferent error. Fundoscopy examination results revealed no abnormality, and the initial Hertel exophthalmos result was 18-87-19.

Computed tomography (CT) examination revealed a large volume of air within the orbital cavity and right eyelid and with a minimal prolapse of the orbital soft tissue. It also revealed a result of disconnection of the right orbital floor into the maxillary antrum.

Axial computed tomography revealed air within the right periorbital region with a little ethmoidal fracture.

Coronal computed tomography showed a large amount of air within the right eyelid.

Coronal computed tomography revealed air within the right orbital cavity. discontinuity of the right orbital floor into the maxillary antrum with minimal prolapse of the orbital soft tissue. Bleeding or thickening conditions are a proof of the right maxillary antral mucosa.

Diagnose Orbital Floor Fracture and Emphysema by Nose Blowing

Orbital emphysema refers to an abnormal condition in which air is present within the facial layers of the periorbital and orbital region. It showed a result up to 50% of fractures involving orbital walls and paranasal sinuses. Air inserts into the orbit and accumulates within the soft tissues through a traumatic communication with paranasal sinuses.

Orbital tissue such as fat may stop the bony breach and acts as a one-way valve across the fracture site permitting air to enter the orbit, but not to leave it. However, nose-blowing, coughing, sneezing, vomiting, and the changing in pressure during air travel procedure can also cause orbital emphysema, even in the absence of mechanical trauma. Rare causes involve necrotizing fasciitis and post septal cellulitis caused by a gas-producing microorganism.

Our patient suffered from orbital floor fracture because of nose blowing without blunt trauma. According to the results and researches with best of our experience, there have been only six other similar reported cases, and three theories usually used to explain the mechanism of orbital fracture include (1) globe to wall contact theory, (2) hydraulic theory, and (3) bone conduction theory.

According to the hydraulic theory examination, in results nose-blowing increases intranasal pressure (INP), which is transferred to the orbit through the dehiscent or broken lamina papyracea or lacerated orbital wall. In normal cases, the increased intranasal pressure during nose blowing act may be up to 9 times higher than during sneezing (75 vs. up to 8.4 mmHg), and very high in chronic sinusitis patients (up to 181.5 mmHg).

The pressure necessary to produce orbital emphysema is less in aged subjects (10–15 mmHg) as compared to the young counterpart (70–100 mmHg) in fractures of the medial orbital wall. 

With the natural aging process, sinus walls become atrophic and probably dehiscent that increases the risk of orbital floor in young counterpart. A congenital fault, a polypoid lesion and an inflammatory procedure may weaken the orbital wall and predispose it to a barotraumatic orbital floor.

In the reported cases of OFFE, the predispose factor are upper respiratory tract infections. In the reported cases of OFFE, the predisposing factors are upper respiratory tract infections. According to the reported 5 cases or a history of a sinus surgery while one patient has no recognizeable factors. Only in one reported case the fracture of the lateral wall of the maxillary sinus is found. 

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