Management of the 'tight orbit' and associated visual loss

Purpose of reviewTo review the most recent literature on the management of the orbit under high pressure (the tight orbit) with threatened visual loss. Recent findingsDefinitive management of traumatic optic neuropathy remains unclear, lacking randomized head-to-head treatment option trials. Instead, numerous case series and anecdotal reports show benefit in each of the four treatment modalities currently in use, but a multitude of variables confound cross-study comparison. In contrast, the management of orbital hemorrhage and orbital emphysema is well known. A number of immunomodulatory protocols have recently arisen for the medical suppression of Graves' ophthalmopathy, but when surgical decompression is required, most authors currently favor a combined transconjunctival and endoscopic endonasal approach. SummaryThis article reviews the anatomy, pathophysiology, diagnosis, and intervention of the tight orbit' with associated visual loss. Guidelines for the intervention are given.