Orbital Compartment Syndrome (OCS): An Ocular Emergency How to Perform a Sight-Saving Lateral Canthotomy and Cantholysis

A young woman displayed a dilated and fixed pupil following a motor vehicle collision with blunt force trauma to face. This was associated with drastically elevated intraocular pressure and proptosis. It was believed that a retrobulbar bleed was causing ocular compartment syndrome, an ischemic condition whereby elevated pressure within the orbit occludes blood flow to the retina and ocular nerves. This is a rare ocular emergency, and must be promptly treated to prevent permanent damage. Ophthalmology was consulted by telephone to confirm the diagnosis and direct treatment. A lateral canthotomy and cantholysis was performed under guidance from Ophthalmology and free open access medical education resources. The trauma team managed to save the eye, with visual acuity remaining near normal. In this report, the mechanism of orbital compartment syndrome is explained, and the lateral canthotomy and cantholysis procedure is outlined. This case highlights the importance of telephone consultation and easily accessible medical education resources in the acute care of rare conditions that may arise following trauma.

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Bony Orbital Decompression Following Lateral Canthotomy and Cantholysis for Traumatic Orbital Compartment Syndrome

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000004902 ◽

2019 ◽

Vol 30 (1) ◽

pp. 231-234 ◽

Cited By ~ 3

Author(s):

Yoshiyuki Kitaguchi ◽

Yasuhiro Takahashi ◽

Maria Suzanne Sabundayo ◽

Hirohiko Kakizaki

Keyword(s):

Compartment Syndrome ◽

Orbital Decompression ◽

Lateral Canthotomy

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Management of acute retrobulbar haemorrhage: a survey of non-ophthalmic emergency department physicians

Emergency Medicine Journal ◽

10.1136/emermed-2018-207937 ◽

2019 ◽

Vol 36 (4) ◽

pp. 245-247 ◽

Cited By ~ 7

Author(s):

Matthew R Edmunds ◽

Anjana S Haridas ◽

Daniel S Morris ◽

Kasyap Jamalapuram

Keyword(s):

Compartment Syndrome ◽

Visual Loss ◽

Online Survey ◽

Response Rate ◽

Case Vignette ◽

Multiple Choice Questions ◽

Out Of Hours ◽

The United Kingdom ◽

Survey Response Rate ◽

Lateral Canthotomy

IntroductionAcute retrobulbar haemorrhage (RBH) with orbital compartment syndrome is a sight-threatening ophthalmic emergency requiring treatment with lateral canthotomy and cantholysis (LC/C). However, such cases may present to non-ophthalmic emergency departments (ED) out-of-hours, when specialist intervention is not readily available. We completed a survey of ED physicians to explore experiences of RBH and confidence in undertaking LC/C.MethodsFrom February to April 2018, an online survey was sent to ED physicians of all training grades in seven UK locations. The survey comprised a case vignette of a patient presenting with clinical features of RBH with orbital compartment syndrome, with multiple choice questions on the diagnosis, management and onward referral of such cases. Additional questions explored the experience of RBH, LC/C and perspectives on current and future training of ED physicians in this area.Results190 ED doctors completed the survey (response rate 70%). While 82.8% correctly diagnosed RBH and 95.7% recognised irreversible visual loss as a consequence of untreated RBH with orbital compartment syndrome, 78.7% indicated that they would initially undertake CT imaging rather than performing LC/C. Only 38.9% had previously encountered a case of RBH and only 37.1% would perform LC/C themselves, with 91.4% indicating that this was due to lack of training. 92.2% felt that more training was required for ED physicians in RBH management and performing LC/C.ConclusionWhile cases of RBH with orbital compartment syndrome are infrequent, it is important that RBH management with the vital, sight-saving skill of LC/C is added to the United Kingdom Royal College of Emergency Medicine training curriculum. At present, though the majority of ED physicians can identify RBH, the minority are willing or able to undertake LC/C, potentially risking irreversible but avoidable visual loss.

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Orbital Compartment Syndrome: Alternative Tools to Perform a Lateral Canthotomy and Cantholysis

Wilderness and Environmental Medicine ◽

10.1016/j.wem.2015.09.002 ◽

2016 ◽

Vol 27 (1) ◽

pp. 85-91 ◽

Cited By ~ 3

Author(s):

Kenneth V. Iserson ◽

Zelda Luke-Blyden ◽

Scott Clemans

Keyword(s):

Compartment Syndrome ◽

Lateral Canthotomy

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Orbitakompartment-szindróma. Arcot ért trauma következtében leggyakrabban vakságot okozó állapot

Orvosi Hetilap ◽

10.1556/650.2017.30850 ◽

2017 ◽

Vol 158 (36) ◽

pp. 1410-1420 ◽

Cited By ~ 1

Author(s):

Gusztáv Klenk ◽

József Katona ◽

Gábor Kenderfi ◽

János Lestyán ◽

Katalin Gombos ◽

...

Keyword(s):

Foreign Body ◽

Compartment Syndrome ◽

Surgical Intervention ◽

Rare Condition ◽

Surgical Decompression ◽

Facial Fractures ◽

Common Cause ◽

Short Period ◽

Retinal Artery ◽

Lateral Canthotomy

Abstract: Introduction: Although orbital compartment syndrome is a rare condition, it is still the most common cause of blindness following simple or complicated facial fractures. Its pathomechanism is similar to the compartment syndrome in the limb. Little extra fluid (blood, oedema, brain, foreign body) in a non-space yielding space results with increasingly higher pressures within a short period of time. Unless urgent surgical intervention is performed the blocked circulation of the central retinal artery will result irreversible ophthalmic nerve damage and blindness. Aim, material and method: A retrospective analysis of ten years, 2007–2017, in our hospital among those patients referred to us with facial-head trauma combined with blindness. Results: 571 patients had fractures involving the orbit. 23 patients become blind from different reasons. The most common cause was orbital compartment syndrome in 17 patients; all had retrobulbar haematomas as well. 6 patients with retrobulbar haematoma did not develop compartment syndrome. Compartment syndrome was found among patient with extensive and minimal fractures such as with large and minimal haematomas. Early lateral canthotomy and decompression saved 7 patients from blindness. Conclusion: We can not predict and do not know why some patients develop orbital compartment syndrome. Compartment syndrome seems independent from fracture mechanism, comminution, dislocation, amount of orbital bleeding. All patients are in potential risk with midface fractures. We have a high suspicion that orbital compartment syndrome has been somehow missed out in the recommended textbooks of our medical universities and in the postgraduate trainings. Thus compartment syndrome is not recognized. Teaching, training and early surgical decompression is the only solution to save the blind eye. Orv Hetil. 2017; 158(36): 1410–1420.

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Traumatic Orbital Compartment Syndrome: A Sight Threatening Emergency

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i1.25439 ◽

2019 ◽

Vol 11 (1) ◽

pp. 91-97

Author(s):

Kinsuk Singh ◽

Gulshan Bahadur Shrestha

Keyword(s):

Emergency Department ◽

Compartment Syndrome ◽

Clinical Diagnosis ◽

Surgical Intervention ◽

Case Series ◽

University Teaching ◽

Orbital Trauma ◽

Rare Presentation ◽

Lateral Canthotomy ◽

Made In

Orbital compartment syndrome is a rare presentation of orbital trauma and is an ophthalmic emergency. Delay in clinical diagnosis and subsequent surgical intervention will lead to loss of vision in nick of time. We presented a case series of orbital compartment syndrome secondary to trauma who presented to the emergency department of Tribhuvan University Teaching Hospital during the devastating earthquake in April 2015. Clinical diagnosis of orbital compartment syndrome was made in the bedside and all the patients underwent emergency lateral canthotomy and inferior cantholysis. This case series was aimed to describe clinical features and management of orbital compartment syndrome.

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