A 47 year old man with asthma, allergic rhinitis, and chronic maxillary and ethmoid sinusitis and polyposis, in whom for 2 years intraorbital pressure symptoms are experienced on nose-blowing, sneezing and coughing, is presented. Paranasal sinus X-rays demonstrated an intraorbital pneumocoele that increased in size with Valsalva manoeuvre. The diagnosis, pathology and treatment of intraorbital emphysema and pneumoceles are discussed.