Acute Orbital Compartment Syndrome Medication
- Author: David A Peak, MD; Chief Editor: Robert E O'Connor, MD, MPH more...
The goal of pharmacotherapy is to reduce morbidity and to prevent complications. Several medications are used to decrease intraocular pressure (IOP) and reduce inflammation and oxidant effects. A local anesthetic is used in patients undergoing emergency decompressive surgery.
These agents decrease IOP by direct osmosis of water.
Mannitol is used to reduce elevated IOP when the pressure cannot be lowered by other means.
Carbonic Anhydrase Inhibitors
These agents decrease IOP by decreasing production of aqueous humor in anterior chamber. Additionally, they reduce systolic blood pressure, which may help control hemorrhage.
Acetazolamide inhibits the enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces IOP. This agent is used for adjunctive treatment of chronic simple (open-angle) glaucoma and secondary glaucoma and preoperatively in acute angle-closure glaucoma when delay of surgery is desired to lower IOP.
These agents exert an anti-inflammatory effect and an antioxidant effect that decreases production of free-radical metabolites.
Methylprednisolone reverses increased capillary permeability.
These agents decrease IOP by decreasing production of aqueous humor.
This agent may reduce elevated and normal IOP, with or without glaucoma, by reducing production of aqueous humor.
Anesthetics that inhibit depolarization of type C sensory neurons are used for decompressive procedures.
Lidocaine is an amide local anesthetic used in a 1-2% concentration. It inhibits depolarization of type C sensory neurons by blocking sodium channels. Lidocaine is available in combination with epinephrine, which prolongs the anesthetic effect and enhances hemostasis (maximum epinephrine dose 4.5-7 mg/kg).
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