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. 2021 Mar 6;2(2):e12372.
doi: 10.1002/emp2.12372. eCollection 2021 Apr.

Orbital compartment syndrome: Pearls and pitfalls for the emergency physician

Shyam Murali  1 , Courtney Davis  1 , Michael J McCrea  1 , Michael C Plewa  1
Affiliations

Orbital compartment syndrome: Pearls and pitfalls for the emergency physician

Shyam Murali et al. J Am Coll Emerg Physicians Open. .

Abstract

Orbital compartment syndrome (OCS) is a rare, vision-threatening diagnosis that requires rapid identification and immediate treatment for preservation of vision. Because of the time-sensitive nature of this condition, the emergency physician plays a critical role in the diagnosis and management of OCS, which is often caused by traumatic retrobulbar hemorrhage. In this review, we outline pearls and pitfalls for the identification and treatment of OCS, highlighting lateral canthotomy and inferior cantholysis (LCIC), a crucial skill for the emergency physician. We recommend adequate preparation for the diagnosis and procedure, early consultation to ophthalmology, clear and thorough documentation of the physical examination, avoidance of iatrogenic injury during LCIC, and complete division of the inferior canthal tendon. Emergency physicians should avoid failing to make the diagnosis of OCS, delaying definitive surgical treatment, overrelying on imaging, failing to decrease intraocular pressure, and failing to exclude globe rupture. The emergency physician should be appropriately trained to identify signs and symptoms of OCS and perform LCIC in a timely manner.

Keywords: inferior cantholysis; intraocular pressure; lateral canthotomy; ocular trauma; ophthalmology; orbital compartment syndrome; retrobulbar hemorrhage.

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Conflict of interest statement

None

Figures

FIGURE 1
FIGURE 1
Supplies necessary for lateral canthotomy and inferior cantholysis
FIGURE 2
FIGURE 2
(A) Graphic representation of computed tomography (CT) orbit at the level of the superior orbital fissure. The proptotic eye is abnormal. Medial rectus muscle is shown in the images. (B) Posterior globe angle as described by Dalley et al. Value < 120 degrees is associated with variable recovery of vision. (C) Stretch angle as described by Oester et al; stretch angle is defined as the angle created by 2 intersecting lines: 1 from the medial rectus insertion to the optic nerve and the second from the nasal sclera to the optic nerve. When the difference between stretch angles for the 2 eyes is calculated, larger values are associated with vision loss
FIGURE 3
FIGURE 3
(A) Computed tomography (CT) scan demonstrating globe tenting and (B) ultrasound images demonstrating “guitar pick sign.” Images taken from Theoret et al with permission from the corresponding author
See this image and copyright information in PMC

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