Ocular compartment syndrome

Background[1]

  • Rare, vision-threatening ophthalmic emergency characterized by an acute elevation of intra-orbital pressure which exceeds the vascular perfusion pressure of the ophthalmic artery.
  • Most commonly caused by acute orbital or facial trauma
  • Less common causes include local injections, orbital infection, orbital emphysema, foreign bodies, and spontaneous hemorrhage

Clinical Features

Differential Diagnosis[2]

Periorbital swelling

Proptosis

No proptosis

Lid Complications

Other

Evaluation

Workup

Do NOT delay treatment for diagnostic studies if there is already a high clinical suspicion for OCS

  • Tonometry (Tono-pen)
    • Do NOT use until globe rupture has been excluded
    • Normal pressure 10-20mmHg; pressure >35mmHg suggests OCS[3]
  • Labs
    • CBC/BMP (if history of trauma or cellulitis)
    • Coag panel (coagulopathy increases risk for retrobulbar hemorrhage)
  • Imaging
    • CT (Orbit)
      • May help identify etiology or exclude diagnoses
      • 75% of OCS cases will show a change in posterior globe configuration ("globe tenting")
    • Ultrasound (orbit)
      • Not been validated for AOCS, but may identify other ocular pathologies (retinal detachment, central retinal artery occlusion, lens dislocation, vitreous hemorrhage, and vitreous detachment[4]

Diagnosis

  • Diagnosis can made clinically with afferent pupillary defect, vision loss, and intraocular pressure >35mmHg

Management

Disposition

  • Admit

See Also

External Links

References

  1. Murchison, A., 2021. Orbital Compartment Syndrome - EyeWiki. [online] Eyewiki.org. Available at: <https://eyewiki.org/Orbital_Compartment_Syndrome> [Accessed 29 June 2021].
  2. Shannon, B., 2019. Acute Orbital Compartment Syndrome Differential Diagnoses. [online] Emedicine.medscape.com. Available at: <https://emedicine.medscape.com/article/799528-differential> [Accessed 29 June 2021].
  3. Stiff, H., 2018. Orbital Compartment Syndrome Curriculum. [online] Eyerounds.org. Available at: <https://eyerounds.org/tutorials/ocs/index.htm> [Accessed 29 June 2021].
  4. Blavias, M., 2002. A study of bedside ocular ultrasonography in the emergency department.. [online] Reference.medscape.com. Available at: <https://reference.medscape.com/medline/abstract/12153883> [Accessed 29 June 2021].