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Acute Orbital Compartment Syndrome Medication

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

Medication Summary

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.

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Hyperosmotic Agents

Class Summary

These agents decrease IOP by direct osmosis of water.

Mannitol (Osmitrol, Aridol)

 

Mannitol is used to reduce elevated IOP when the pressure cannot be lowered by other means.

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Carbonic Anhydrase Inhibitors

Class Summary

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 (Diamox)

 

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.

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Corticosteroids

Class Summary

These agents exert an anti-inflammatory effect and an antioxidant effect that decreases production of free-radical metabolites.

Methylprednisolone (Solu-Medrol, A-Methapred, Depo-Medrol)

 

Methylprednisolone reverses increased capillary permeability.

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Beta-blockers

Class Summary

These agents decrease IOP by decreasing production of aqueous humor.

Timolol ophthalmic (Betimol, Timoptic, Istalol)

 

This agent may reduce elevated and normal IOP, with or without glaucoma, by reducing production of aqueous humor.

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Local Anesthetics

Class Summary

Anesthetics that inhibit depolarization of type C sensory neurons are used for decompressive procedures.

Lidocaine (Akten)

 

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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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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