Complications of Orbital Emphysema in a COVID-19 Patient

A 74-year-old man presented with a 10-day history of fever, cough, and progressive dyspnea. The patient was diagnosed with severe pneumonia related to COVID-19, after a positive polymerase chain reaction test and radiographic imaging (Fig A). The hospital course was complicated by respiratory failure requiring orotracheal intubation. Refractory hypoxia prompted increased levels of positive end-expiratory pressure (up to 18 cm H₂O) and prone positioning. Upon supination, subcutaneous emphysema extended from the chest to the face, unilaterally in the conjunctiva (Fig B), and bilaterally around the eyelids (Fig C). Complete ophthalmologic examination did not reveal any evidence of orbital compartment syndrome or vascular occlusion. (Magnified version of Fig A-C is available online at www.aaojournal.org).