Acute Orbital Compartment Syndrome Medication

Updated: Jun 06, 2019
  • Author: Bryant C Shannon, MD; Chief Editor: Gregory Sugalski, MD  more...
  • Print
Medication

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, including steroids, hyperosmotic agents, and carbonic anhydrase inhibitors. [3]

Next:

Hyperosmotic Agents

Class Summary

These agents decrease IOP by direct osmosis of water in the orbit.

Mannitol (Osmitrol, Aridol)

Mannitol is used for immediate pressure relief by osmotically shrinking the vitreous and dehydrating the intraorbital and intraocular spaces.

Previous
Next:

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, decreasing IOP, but not acutely. 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.

Previous
Next:

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.

Dexamethasone (Baycadron, Decadron, Dexamethasone Intensol)

Dexamethasone reduces inflammation and stabilizes the cell membrane against ischemic damage.

Previous
Next:

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.

Previous
Next:

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).

Previous