Acute Orbital Compartment Syndrome Workup
- Author: David A Peak, MD; Chief Editor: Robert E O'Connor, MD, MPH more...
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.
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].
McInnes G, Howes DW. Lateral canthotomy and cantholysis: a simple, vision-saving procedure. CJEM. 2002 Jan. 4(1):49-52. [Medline].
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].
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].
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].