eMedicine Specialties > Emergency Medicine > Ophthalmology

Acute Orbital Compartment Syndrome: Follow-up

Author: David A Peak, MD, Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary
Contributor Information and Disclosures

Updated: Nov 3, 2009

Follow-up

Further Inpatient Care

  • Cosmetic repair of lateral canthotomy may be performed in the hospital and usually affords a good outcome. Repair of canthal tendons can be performed at the discretion of the specialist. Repair can be delayed for several days if necessary.
  • Compartment syndrome is one of the accepted indications for hyperbaric oxygen therapy. Case reports of improvement in vision using hyperbaric oxygen as adjunct therapy in acute orbital compartment syndrome exist.

Transfer

  • Transfer for specialty consultation and/or further workup (including CT scan or MRI) is indicated when an acute orbital compartment syndrome diagnosis is entertained.
  • Initiate treatment prior to transfer in patients with visual acuity loss or rapidly evolving symptoms with signs of increased IOP.

Deterrence/Prevention

  • Prevention of morbidity (visual loss) depends on early diagnosis and treatment.

Complications

  • Irreversible visual loss can be expected with retinal ischemia that lasts longer than 120 minutes.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to make the diagnosis
  • Failure to initiate prompt therapy
  • Ordering time-consuming diagnostic tests in patients with visual acuity loss or rapidly advancing symptoms prior to initiation of therapy
  • Failure to initiate therapy in patients with visual acuity loss or rapidly advancing symptoms or signs prior to transfer
  • Failure to obtain emergent specialty consultation
 


More on Acute Orbital Compartment Syndrome

Overview: Acute Orbital Compartment Syndrome
Differential Diagnoses & Workup: Acute Orbital Compartment Syndrome
Treatment & Medication: Acute Orbital Compartment Syndrome
Follow-up: Acute Orbital Compartment Syndrome
Multimedia: Acute Orbital Compartment Syndrome
References
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References

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Further Reading

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Keywords

acute orbital compartment syndrome, retrobulbar hematoma, orbital compartment syndrome, intraorbital hemorrhage, subperiosteal hematoma of the orbit, ACON, acute compressive optic neuropathy, orbital injuries, ocular injuries, lateral canthotomy, inferior cantholysis

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Contributor Information and Disclosures

Author

David A Peak, MD, Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary
David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Medical Editor

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, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

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 College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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