Orbital compartment syndrome

Background

Eye anatomy.
  • Rare, vision-threatening ophthalmic emergency characterized by an acute elevation of intra-orbital pressure which exceeds the vascular perfusion pressure of the ophthalmic artery.[1]
  • Most commonly caused by acute orbital or facial trauma
  • Less common causes include local injections, orbital infection, orbital emphysema, foreign bodies, and spontaneous hemorrhage

Clinical Features

Differential Diagnosis

Periorbital swelling

Proptosis

No proptosis

Lid Complications

Other

Evaluation

Computed tomography demonstrating left retrobulbar hemorrhage with proptosis.

Workup

Do NOT delay treatment for diagnostic studies if there is already a high clinical suspicion for OCS

  • Tonometry (Tono-pen)
    • Do NOT use until globe rupture has been excluded
    • Normal pressure 10-20mmHg; pressure >35mmHg suggests OCS[3]
  • Labs
    • CBC/BMP (if history of trauma or cellulitis)
    • Coag panel (coagulopathy increases risk for retrobulbar hemorrhage)
  • Imaging
    • CT (Orbit)
      • May help identify etiology or exclude diagnoses
      • 75% of OCS cases will show a change in posterior globe configuration ("globe tenting")
    • Ultrasound (orbit)
      • Not been validated for AOCS, but may identify other ocular pathologies (retinal detachment, central retinal artery occlusion, lens dislocation, vitreous hemorrhage, and vitreous detachment[4]

Diagnosis

  • Diagnosis can made clinically with afferent pupillary defect, vision loss, and intraocular pressure >35mmHg

Management

Disposition

  • Admit

See Also

External Links

References

  1. Murchison, A., 2021. Orbital Compartment Syndrome - EyeWiki. [online] Eyewiki.org. Available at: <https://eyewiki.org/Orbital_Compartment_Syndrome> [Accessed 29 June 2021].
  2. Shannon, B., 2019. Acute Orbital Compartment Syndrome Differential Diagnoses. [online] Emedicine.medscape.com. Available at: <https://emedicine.medscape.com/article/799528-differential> [Accessed 29 June 2021].
  3. Stiff, H., 2018. Orbital Compartment Syndrome Curriculum. [online] Eyerounds.org. Available at: <https://eyerounds.org/tutorials/ocs/index.htm> [Accessed 29 June 2021].
  4. Blavias, M., 2002. A study of bedside ocular ultrasonography in the emergency department.. [online] Reference.medscape.com. Available at: <https://reference.medscape.com/medline/abstract/12153883> [Accessed 29 June 2021].
  5. Emam HA, Stevens MR, Larsen PE, et al. Lateral tarsotomy: a practical alternative to lateral canthotomy to increase or- bital access. Oral Surg Oral Med Oral Pathol Oral Radiol 2016;122:e1–4