Back to Basics: Orbital Compartment Syndrome
Retrobulbar Hematoma and Orbital Compartment Syndrome
Retrobulbar hematoma - bleeding into the post-septal space classically caused by blunt trauma to the eye, can lead to orbital compartment syndrome
Orbital compartment syndrome: intraocular pressure (IOP) >40mmHg (Normal IOP: 10-21mmHg) in setting of retrobulbar hematoma
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--> Causes compression of ophthalmic artery and ocular nerve which can lead to ischemia and vision loss
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--> Signs and symptoms include proptosis, decreased visual acuity, afferent pupillary defect, ophthalmoplegia, severe eye pain
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--> Treatment is emergency lateral canthotomy and ophthalmology consult
How to Perform a Lateral Canthotomy
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Clean lateral canthus with antiseptic solution
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Inject lidocaine with epinephrine in lateral canthus
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Crush lateral canthus with hemostat for 1-2 minutes
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Cut lateral canthus with iris scissors - incision should be approximately 1-2cm in length and depth
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Retract lower lid to reveal lateral canthal tendon
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Cut inferior crus of lateral canthal tendon
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Repeat IOP measurement
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If pressure remains elevated >40mmHg, should cut superior crus
Complications - bleeding, infection, mechanical injury to surrounding structures
References:
Knoop, K. And Dennis, W. “Ophthalmologic Procedures.” Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 7th Ed. James R. Roberts, et al. Philadelphia, PA: Elsevier, 2019.
Walker, R and Adhikari, S.. “Eye Emergencies.” Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th Ed. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016.