Orbital Compartment Syndrome: How a Young Man’s Vision was Saved by the Timely Actions of an Emergency Medicine Physician

Houck, Jessica; Mangal, Rohan; Vandillen, Chrissy; Ganti, Latha; Sleigh, Bryan C

doi:10.7759/cureus.5057

Cited by 4 publications

(6 citation statements)

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“…Bei Einblutungen nach Trauma oder nach endonasaler Nasennebenhöhlen Operation mit erheblicher Erhöhung des intraorbitalen Druckes kann als Erstmaßnahme mittels einer lateralen Kanthotomie bzw. einer Kantholyse mit transpalpebraler Eröffnung des Septum orbitale eine Reduktion des intraorbitalen Druckes erreicht werden [26,27]. Die Drucksenkung bei einer lateralen Kanthotomie beträgt bis zu 14,2 mmHg, bei einer Kantholyse 30,4 mmHg [28].…”

Section: Therapieunclassified

Interdisziplinäre Therapie der Erkrankungen der Orbita

Eckstein,

Welkoborsky

2024

Laryngorhinootologie

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ZusammenfassungDie Diagnostik und Therapie von Erkrankungen der Orbita ist eine interdisziplinäre Aufgabe, an der u.a. die Fachdisziplinen HNO-Heilkunde, Augenheilkunde, Radiologie, Strahlentherapie, MKG-Chirurgie, Endokrinologie und Pädiatrie beteiligt sind. Der vorliegende Übersichtsartikel stellt eine Zusammenstellung der häufigsten Erkrankungen dar, mit denen die Fachdisziplinen HNO-Heilkunde und Augenheilkunde interdisziplinär befasst sind. Es werden die akuten entzündlichen Erkrankungen incl. orbitaler Komplikationen, die autoimmunologischen Erkrankungen der Orbita incl. der endokrinen Orbitopathie, und die tumorösen Erkrankungen besprochen. Neben der Diagnostik und der Beschreibung der Klinik wird besonderes Augenmerk auf die interdisziplinäre Therapie gelegt. Abgerundet wird der Übersichtsartikel mit der Beschreibung der wichtigsten chirurgischen Zugangswege zur Orbita, ihre Indikationen und mögliche Komplikationen. Die Autoren haben versucht, trotz der knappen Darstellung die relevanten Fakten zu beschreiben.

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Section: Therapieunclassified

Interdisziplinäre Therapie der Erkrankungen der Orbita

Eckstein,

Welkoborsky

2024

Laryngorhinootologie

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“…The most frequent cause is traumatic blowout orbital fractures through compromising the laminae papyracea which constitutes most of the medial wall of the orbit. 1,[4][5][6] However, alternative pathways, including gas-forming infection, barotrauma, and iatrogenic elements like dental surgery or chest tube insertion, have been documented. 2,3 Proptosis, crepitus, and diplopia are among the signs and symptoms that might appear suddenly or develop gradually over a period of days to weeks.…”

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confidence: 99%

“…Proptosis, crepitus, and diplopia are among the signs and symptoms that might appear suddenly or develop gradually over a period of days to weeks. Even though OE normally has a benign course and self-limits, it can cause visual loss in extreme cases by elevating the intraorbital pressure significantly enough causing orbital compartment syndrome (OCS) leading to compromising of neurovascular structures and thus threatening permanent visual loss through retinal ischemia, requiring urgent decompression or air aspiration 4–6 . Features that might suggest concern include intense proptosis, elevated intraocular pressure (IOP) with retinal vascular pulsation, restricted ocular motility, afferent pupillary defect, and loss of vision.…”

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confidence: 99%

“…Even though OE normally has a benign course and self-limits, it can cause visual loss in extreme cases by elevating the intraorbital pressure significantly enough causing orbital compartment syndrome (OCS) leading to compromising of neurovascular structures and thus threatening permanent visual loss through retinal ischemia, requiring urgent decompression or air aspiration. [4][5][6] Features that might suggest concern include intense proptosis, elevated intraocular pressure (IOP) with retinal vascular pulsation, restricted ocular motility, afferent pupillary defect, and loss of vision. Imaging is of paramount importance to demonstrate the pattern and site of air pockets and also tenting of the posterior globe at the attachment of the optic nerve, implying extreme orbital tension and the risk to optic nerve compressive neuropathy.…”

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confidence: 99%

“…The collection of air or gas into the orbital soft tissue space is referred to as orbital emphysema (OE). The most frequent cause is traumatic blowout orbital fractures through compromising the laminae papyracea which constitutes most of the medial wall of the orbit 1,4–6 . However, alternative pathways, including gas-forming infection, barotrauma, and iatrogenic elements like dental surgery or chest tube insertion, have been documented 2,3 .…”

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Emergency Decompression of Orbital Emphysema, a Sight-Saving Tool in a Patient With Precious Eye

Abdelazeem,

Barhoma,

Samir

2024

Journal of Craniofacial Surgery

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A woman, 19 years old, with a history of falling from a height with resulting zygomatico-maxillar complex fracture on the right side, a mandibular fracture on the left side for which she underwent repair with plate insertion, and traumatic optic atrophy in her right eye, presented 9 months later with eye facial swelling, proptosis, and acute rapid loss of vision in the left eye. The diagnosis was done immediately aided by radiology assistance and a decision was taken to admit the patient to undergo urgent decompression to save the vision and the patient did recover well. This case presented here and the associated literature review focus on severe orbital emphysema with compressive optic neuropathy and orbital compartment syndrome as a morbidity that can exist with delayed presentation after trauma and not elicited by sneezing or forced blowing, as well as the drastic importance of brisk intervention, to save vision and prevent visual complications if left untreated.

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Lateral Canthotomy/Cantholysis Performance Gap Analysis and Training Recommendations for Expeditionary Physicians

et al. 2022

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Introduction Preservation of life, preservation of limb, and preservation of eyesight are the priorities for military medical personnel when attending to casualties. The incidences of eye injuries in modern warfare have increased significantly, despite personal eye equipment for service members. Serious eye injuries are often overlooked or discovered in a delayed fashion because they accompany other life- and limb-threatening injuries, which are assigned a higher priority. Prehospital military ocular trauma care is to shield the eye and evacuate the casualty to definitive ophthalmic care as soon as possible, with exceptions for treatment of ocular chemical injury and orbital compartment syndrome. Retrospective analysis of eye injuries in recent conflicts identified gaps in clinical capabilities with up to 96% of ocular injuries being suboptimally managed. Ocular compartment syndrome (OCS) is a complication associated with orbital hemorrhage, where significant morbidity occurs as a result of increasing intracompartment pressure. The ischemic tolerance of the retina and optic nerve is approximately 90 minutes, so OCS must be rapidly diagnosed and aggressively treated through lateral canthotomy/cantholysis (LC/C) to prevent permanent vision loss. LC/C procedures consist of using hemostats to crush the lateral canthal fold and cutting the lateral canthal tendon from the inferior crus to relieve increasing intracompartment pressure. The purpose of this study was to examine the baseline capabilities of military physicians and surgeons to accurately and independently perform the LC/C procedures and identify performance gaps that could be closed through focused professional development activities. Materials and Methods This study received institutional review board approval at our institution. A total of 60 subjects voluntarily participated in the study from emergency medicine (15), general surgery (28), and ophthalmology (17). All procedural assessments were performed 1:1 by expert faculty ocular trauma specialists using a high-reliability eye trauma simulator (Sonalysts, Inc.). The competency standard was set at independent and accurate completion of all procedural components and all critical procedural components. Analyses were performed using descriptive statistics and analysis of variance to examine between-group differences (P < 0.05). Results There was a significant difference between the total score performance and the critical score performance for the three groups (P < 0.001). Outcomes indicate a significant linear relationship between the expertise level of the clinical provider and the procedural performance of LC/C. Outcomes demonstrate the baseline surgical capabilities of the general surgeons transferred to LC/C performance; however, they were unfamiliar with the anatomy and the procedural techniques and requirements. The group of emergency medicine participants demonstrated performance gaps not only in the same areas as the general surgeons but also in their baseline surgical abilities. This suggests that different professional development activities are necessary for surgeons and physicians tasked with performing LC/V procedures. Conclusions We identified significant performance gaps among emergency medicine physicians, general surgeons, and ophthalmologists in their abilities to recognize and treat OCS through LC/C procedures. These sight-saving procedures are a critical competency for forward-situated clinicians in expeditionary contexts. We identified the need for targeted approaches to professional development for closing the performance gaps for both emergency medicine physicians and general surgeons.

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Orbital Compartment Syndrome: How a Young Man’s Vision was Saved by the Timely Actions of an Emergency Medicine Physician

Cited by 4 publications

References 5 publications

Interdisziplinäre Therapie der Erkrankungen der Orbita

Interdisziplinäre Therapie der Erkrankungen der Orbita

Emergency Decompression of Orbital Emphysema, a Sight-Saving Tool in a Patient With Precious Eye

Lateral Canthotomy/Cantholysis Performance Gap Analysis and Training Recommendations for Expeditionary Physicians

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