Traumatic orbital compartment syndrome: Importance of the lateral canthomy and cantholysis

Background Orbital compartment syndrome (OCS) is an ophthalmic emergency that requires urgent surgical decompression to preserve vision. Objective To describe the clinical presentation, management and outcomes for patients with traumatic OCS. Methods Retrospective case series of eight patients with OCS secondary to blunt trauma presenting to the Royal Adelaide Hospital between 2004 and 2013. Results All patients had acute, painful decrease in visual acuity and proptosis. Common examination findings included a relative afferent pupillary defect, periorbital oedema, ophthalmoparesis and chemosis. All patients underwent surgical decompression in the form of a lateral canthotomy or cantholysis. Three patients who were decompressed within 2h after injury recovered fully. One patient who sustained a macular hole at the time of injury recovered four lines of Snellen acuity after being decompressed within 1h. Another patient recovered three lines of Snellen acuity after undergoing decompression at 2.5h post-injury. The remaining patients had minimal visual recovery, with postoperative visual acuities ranging from hand movements to no perception to light. Of these patients, one was decompressed at 2h, while the remaining underwent decompression at 4 and 6h post-injury. Conclusions Prompt decompression is essential for visual recovery in OCS, which appears maximal if performed within 2h of injury. All patients presenting with history and examination findings suggestive of OCS should undergo emergency canthotomy and cantholysis prior to any additional investigations to minimise visual loss.