From cabin pressure to orbital pressure: subperiosteal hematoma unmasking a frontal sinus hematoma.

We describe the first case of a subperiosteal orbital hematoma complicating acute barotraumatic frontal sinusitis during a plane landing. A 38-year-old woman presented with a sudden-onset and intense left periorbital pain during a plane landing. Few hours after a commercial flight landing, she presented a delayed left periorbital ecchymosis and left subperiosteal orbital hematoma. An exclusively endoscopic approach effectively drained both the frontal submucosal and orbital subperiosteal hematomas. This approach not only resolved the sinus pathology but also restored ocular function, with significant improvement in visual acuity, normalization of intraocular pressure, and eye movements. The procedure demonstrated the safety and efficacy of endoscopic techniques for addressing complex sinus and orbital complications. The combination of a preexisting bony lysis caused by chronic frontal sinusitis and barometric pressure changes likely facilitated hematoma formation. The delayed onset of symptoms, including left periorbital ecchymosis, proptosis, and visual impairment, highlights the complex pathogenesis and diagnostic challenges of subperiosteal orbital hematoma in such cases.