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Acute Orbital Compartment Syndrome Workup

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

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.

 
 
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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