Acute Orbital Compartment Syndrome Workup

  • Author: David A Peak, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Aug 19, 2011
 

Approach Considerations

Perform direct funduscopy on all patients with suspected orbital compartment syndrome and repeat serially if symptoms evolve. Record intraocular pressure (IOP) as an integral component of the examination. Serial examinations are prudent if one is entertaining the diagnosis of acute orbital compartment syndrome.

No laboratory studies are absolutely indicated in the workup of these patients. Baseline routine laboratory evaluation may be requested for a patient who requires urgent medical treatment or urgent surgical decompression. Consider blood dyscrasia and use of anticoagulant or platelet-inhibiting drugs, which may prolong bleeding time.

CT scan or MRI of the orbit may help to identify the etiology of compression, to exclude alternative diagnoses, and to establish the diagnosis. Finding of a retrobulbar hematoma on CT scan for a patient with clinical findings suggestive of acute ocular compartment syndrome confirms the diagnosis.

In patients with severe symptoms (eg, change in visual acuity) or rapidly evolving symptoms and signs consistent with increased IOP, however, imaging may delay sight-saving therapy and result in permanent vision loss. In these cases, initiate therapy before imaging studies.

Proceed to Treatment & Management
 
 
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.

Coauthor(s)

Thomas E Green, DO, MPH, FACOEP  Attending Physician, Emergency Department, Franciscan Saint James Hospital; Assistant Professor and Core Faculty, Associate Program Director, Emergency Medicine Residency, Chicago College of Osteopathic Medicine at Midwestern University

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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.

Additional Contributors

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. Jul-Aug 2009;54(4):441-9. [Medline].

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

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

  4. 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. Summer 2009;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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