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Acute Orbital Compartment Syndrome Clinical Presentation

  • Author: David A Peak, MD; Chief Editor: Robert E O'Connor, MD, MPH  more...
 
Updated: Nov 04, 2015
 

History

Symptoms of acute orbital compartment syndrome may include the following:

  • Eye pain
  • Diplopia
  • Visual loss
  • Reduction of ocular motility
  • Proptosis
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Physical Examination

Physical examination findings of acute orbital compartment syndrome may include the following:

  • Proptosis (best visualized in coronal/superior view while the patient is in a semi-reclining position)
  • Ecchymosis of eyelids
  • Chemosis - Often severe and may be bloody
  • Ophthalmoplegia
  • Afferent pupillary defect
  • Decreased visual fields
  • Papilledema
  • Decreased visual acuity
  • Central retinal artery pulsation
  • Pale optic disc (late)
  • Cherry-red macula (rare)

Visual acuity may be measured in the patient with acute trauma via a handheld eye chart or even counting fingers at a distance. Acuity should be rechecked at periodic intervals, and any decrease is cause for concern.

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Contributor Information and Disclosures
Author

David A Peak, MD Associate Residency Director of Harvard Affiliated Emergency Medicine Residency; Attending Physician, Massachusetts General Hospital; Assistant Professor, Harvard Medical School

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, American Medical Association

Disclosure: Partner received salary from Pfizer for employment.

Coauthor(s)

Thomas E Green, DO, MPH, FACOEP, FACEP Associate Dean for Clinical Affairs, Des Moines University College of Osteopathic Medicine; Attending Physician, Emergency Department, Emergency Practice Associates; Associate Professor of Emergency Medicine, Midwestern University, Chicago College of Osteopathic Medicine

Thomas E Green, DO, MPH, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Association for Physician Leadership, American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Heart Association, Medical Society of Delaware, Society for Academic Emergency Medicine, Wilderness Medical Society, American Medical Association, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Richard Lavely, MD, JD, MS, MPH Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine

Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, American Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of Tyson Pillow, MD, to the development and writing of the source article.

References
  1. Lima V, Burt B, Leibovitch I, Prabhakaran V, Goldberg RA, Selva D. Orbital compartment syndrome: the ophthalmic surgical emergency. Surv Ophthalmol. 2009 Jul-Aug. 54(4):441-9. [Medline].

  2. McInnes G, Howes DW. Lateral canthotomy and cantholysis: a simple, vision-saving procedure. CJEM. 2002 Jan. 4(1):49-52. [Medline].

  3. Oester AE Jr, Fowler BT, Fleming JC. Inferior orbital septum release compared with lateral canthotomy and cantholysis in the management of orbital compartment syndrome. Ophthal Plast Reconstr Surg. 2012 Jan-Feb. 28(1):40-3. [Medline]. [Full Text].

  4. Holt GR, Holt JE. Incidence of eye injuries in facial fractures: an analysis of 727 cases. Otolaryngol Head Neck Surg. 1983 Jun. 91(3):276-9. [Medline].

  5. Ballard SR, Enzenauer RW, O'Donnell T, Fleming JC, Risk G, Waite AN. Emergency lateral canthotomy and cantholysis: a simple procedure to preserve vision from sight threatening orbital hemorrhage. J Spec Oper Med. 2009 Summer. 9(3):26-32. [Medline].

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Lateral canthotomy is performed by incising laterally with sharp scissors.
Cantholysis is performed by identification and disinsertion of the inferior crus of the lateral canthal tendon, which should allow free mobility of the lower lid margin.
 
 
 
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