The “tight orbit”: Incidence and management of the orbital compartment syndrome

Orbital compartment syndrome resulting in unilateral blindness in two dogs

“…Presenting signs include peracute deterioration in visual acuity, diplopia and PLR abnormalities (Soare et al, 2015;Broadway, 2016). Patients experience a rapid and painful increase in orbital pressure with severe swelling of the adnexae, tense lids, exophthalmia, reduced or absent eye movement, and globe tenting in 75% of cases (Lima et al, 2009;Sun et al, 2014;Soare et al, 2015;Voss et al, 2016). In the above two case reports, very similar signs were noted: the severe facial swelling and exophthalmos occurred acutely and were associated with pain on opening of the mouth and globe tenting.…”

“…Traumatic intraorbital bleeding and maxillo-facial surgeries are the main causes. Orbital compartment syndrome has also been described following fulminant orbital cellulitis/abscess and after spinal surgeries in prone position (Lima et al, 2009;Sun et al, 2014;Voss et al, 2016). In more than 75% of OCS cases "globe tenting", defined as a posterior globe angle of less than 130°, is reported and is considered a specific feature of increased intraorbital pressure (Dalley et al, 1989;Sun et al, 2014).…”

“…The eye remains in place due to the extraocular muscles as well as the upper and lower eyelids, which are attached to the orbital rim by the medial and lateral canthal ligaments, and the inferior and superior septum. The ON has 8 mm of redundant length to accommodate eye movement (Voss et al, 2016). Dogs have increased orbital expansion and facility to displace the globe due to an incomplete bony orbit and generally a more elongated skull.…”

“…Orbital decompression should not be delayed by any diagnostic work-up, such as diagnostic imaging. Surgical intervention consists mainly of lateral canthotomy and cantholysis, however in severe cases, an orbitotomy may be necessary to achieve adequate decompression of the orbit (Sun et al, 2014;Soare et al, 2015;Voss et al, 2016). The dogs described here were referred more than 2 hours after the development of clinical signs and were already blind in the affected eye.…”

Complications of Facial Trauma of the Fronto-orbital Region

“…The incidence of OCS is reported between 0.008 and 2.4% depending on the cohorts inclusion criteria, but they all paint the same picture; it is an uncommon occurrence in orbital trauma but one that requires immediate action and risks permanent vision loss if emergent decompression is not done. [2][3][4][5][6][7] A rare cause of OCS can be from a common finding: orbital emphysema. There have been reported cases of minimally displaced fractures acting as a one-way valve; therefore, any nose blowing, sneezing, or positive pressure forces air into the orbit without the ability to relieve the pressure.…”