Orbital Compartment Syndrome despite Significant Traumatic Expansion of the Orbital Cavity

Gupta, Deepak; Beigi, Bijan

doi:10.1055/s-0036-1592084

Cited by 4 publications

(14 citation statements)

References 16 publications

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“…Out of 116 articles, only eight studies were selected based on whole manuscript reading (►Table 1). 3,[9][10][11][13][14][15][16] We also describe two cases that presented to our trauma center after facial blunt-type trauma with displaced orbital fractures and concomitant OCS that required emergent lateral canthotomy (►Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…5,10 Theoretically, orbital fractures increase orbital volume and provide an egress for the retrobulbar hematoma into the maxillary sinus or nasal cavity, therefore giving a false sense of relief protecting against OCS (orbitotomy and deliberate orbital wall fracture are recommended therapeutic measures in the case of a failed resolution of OCS with canthotomy and cantholysis). 13,19,20 We now know that OCS occurs with or without orbital fractures. 13 A possible explanation behind this lies in the presence of Koorneef's fibrous septa dividing the orbital fat into several compartments, 20,21 and the possible "plugging" of the orbital floor by the inferior rectus or sinus mucosa.…”

Section: Pathophysiologymentioning

confidence: 99%

“…13,19,20 We now know that OCS occurs with or without orbital fractures. 13 A possible explanation behind this lies in the presence of Koorneef's fibrous septa dividing the orbital fat into several compartments, 20,21 and the possible "plugging" of the orbital floor by the inferior rectus or sinus mucosa. However, orbital fractures more likely cause extraconal hematomas which in this study is the most common cause of compartment syndrome (60% extraconal, 20% combined intraconal and extraconal).…”

Section: Pathophysiologymentioning

confidence: 99%

“…Posterior tenting of the globe (posterior angle <120 degrees on CT imaging of the orbits) with acute proptosis was found in 33.3% (6/18) of cases in our study (with an average of 107 degrees) and this combination of signs is associated with a poor prognosis, 23 therefore, its absence (5/18 patients, 27.8%), does not preclude a cantholysis and inferior-lateral canthotomy which should be attempted because its benefits outweigh its risks. 1,13 Prompt treatment should not be delayed by fundoscopic, paraclinical exams and imaging modalities. 1,13 Management Medical management of an OCS includes bed rest, head of bed elevation, ice packs, avoidance of straining, acetazolamide 500 mg PO, or IV methylprednisolone 30 mg/kg bolus then 5.4 mg/kg/h/24 h continued PO 250 mg/12 h, IV mannitol, and treatment of an underlying hypertensive episode or coagulation disorder.…”

Section: History Physical Examination and Paraclinical Studiesmentioning

confidence: 99%

“…1,13 Prompt treatment should not be delayed by fundoscopic, paraclinical exams and imaging modalities. 1,13 Management Medical management of an OCS includes bed rest, head of bed elevation, ice packs, avoidance of straining, acetazolamide 500 mg PO, or IV methylprednisolone 30 mg/kg bolus then 5.4 mg/kg/h/24 h continued PO 250 mg/12 h, IV mannitol, and treatment of an underlying hypertensive episode or coagulation disorder. 5 However, a medical treatment should only be undertaken in mild cases without VA deterioration as the exact efficacy of these agents is uncertain and any change in VA, symptoms, or regular IOP exams should prompt emergent surgical treatment.…”

Section: History Physical Examination and Paraclinical Studiesmentioning

confidence: 99%

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Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic Review

et al. 2021

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Orbital compartment syndrome (OCS) is an emergency that complicates intra-orbital, retrobulbar hemorrhage in most cases. Bony orbital decompression is an effective treatment for OCS, and displaced orbital fractures are protective. Nevertheless, in rare cases, OCS occurs despite a displaced orbital fracture. The aim of the current review is to present its pathophysiology and management based on what is published in the medical literature, and our center's experience. A systematic review of literature was conducted through PubMed, Medline, Embase, and Cochrane from inception through February 2021. The following search query was used: “orbital fracture” and “trauma” and “orbital compartment syndrome.” Studies tackling the pathophysiology and management of concurrent displaced orbital fracture with OCS were included and a cohort of patients was constituted. A cohort of 18 cases reported in the literature were included (49.3 ± 30.6 years, 50% M). Given that OCS occurs with or without orbital fracture, pathophysiology of OCS is mostly explained by the division of the orbital fat into many compartments, due to the presence of Koorneef's fibrous septa. Management of OCS in such circumstances consisted of inferior-lateral canthotomy and cantholysis in 50% of cases, subperiosteal drainage with myringotomy in 22.2% of cases, subperiosteal drainage in 16.7% of cases, and complete lateral cantholysis in 16.7% of cases. Two cases who presented to our tertiary care center were also added to this review. Physicians should be aware that OCS can occur even with displaced fractures of the orbital cavity. When clinical suspicion is present, an emergent management is needed.

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Section: Methodsmentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Section: History Physical Examination and Paraclinical Studiesmentioning

confidence: 99%

Section: History Physical Examination and Paraclinical Studiesmentioning

confidence: 99%

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Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic Review

et al. 2021

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Emergency Decompression of Orbital Emphysema, a Sight-Saving Tool in a Patient With Precious Eye

Abdelazeem,

Barhoma,

Samir

2024

Journal of Craniofacial Surgery

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A woman, 19 years old, with a history of falling from a height with resulting zygomatico-maxillar complex fracture on the right side, a mandibular fracture on the left side for which she underwent repair with plate insertion, and traumatic optic atrophy in her right eye, presented 9 months later with eye facial swelling, proptosis, and acute rapid loss of vision in the left eye. The diagnosis was done immediately aided by radiology assistance and a decision was taken to admit the patient to undergo urgent decompression to save the vision and the patient did recover well. This case presented here and the associated literature review focus on severe orbital emphysema with compressive optic neuropathy and orbital compartment syndrome as a morbidity that can exist with delayed presentation after trauma and not elicited by sneezing or forced blowing, as well as the drastic importance of brisk intervention, to save vision and prevent visual complications if left untreated.

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Traumatic Orbital Compression Syndromes: A Comprehensive Study Into Etiologies, Intervention Strategies, and Clinical Outcomes

Dos Santos,

Gorla,

Moreno

et al. 2024

Journal of Craniofacial Surgery

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Facial fractures and their historical link to potential blindness have been well-documented, often attributed to optic canal injuries or retinal vascular occlusion. This dire consequence can result from both direct and indirect ocular trauma, including retrobulbar hemorrhage. Traumatic orbital compression can manifest in various forms, such as hematomas, fractured bone fragments, and emphysema, all posing a significant threat to vision, necessitating immediate intervention. In this study, 9 clinical cases of traumatic orbital compression are presented, each characterized by distinct etiologies. The study delves into traumatic orbital compressive syndromes, underscoring the critical imperative of early recognition and treatment to prevent vision loss. Orbital compression, whether from edema, hematoma, or emphysema, collectively culminates in elevated intraorbital pressure and the potential for optic nerve ischemia. Through the presentation of these 9 clinical cases, the article emphasizes the pressing need for timely intervention in addressing orbital compressive syndromes to avert vision loss. Various surgical techniques are elucidated, highlighting the pivotal role of expeditious medical intervention. This article offers invaluable insights into the diagnosis, management, and outcomes of traumatic orbital compressive syndromes.

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Orbital Compartment Syndrome despite Significant Traumatic Expansion of the Orbital Cavity

Cited by 4 publications

References 16 publications

Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic Review

Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic Review

Emergency Decompression of Orbital Emphysema, a Sight-Saving Tool in a Patient With Precious Eye

Traumatic Orbital Compression Syndromes: A Comprehensive Study Into Etiologies, Intervention Strategies, and Clinical Outcomes

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