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Mungroo KA, Song A, Greenstein J, Hahn B. Man With Proptosis. Ann Emerg Med 2023; 82:438-448. [PMID: 37739747 DOI: 10.1016/j.annemergmed.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 09/24/2023]
Affiliation(s)
| | - Alexander Song
- Department of Radiology, Staten Island University Hospital, Staten Island, NY
| | | | - Barry Hahn
- Department of Emergency Medicine, Staten Island, NY
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Maier C, Thieme N, Beck-Broichsitter B, Beetz NL, Walter-Rittel TC, Rubarth K, Heiland M, Kreutzer K, Koerdt S, Voss JO. Imaging the Tight Orbit: Radiologic Manifestations of Orbital Compartment Syndrome. AJNR Am J Neuroradiol 2023; 44:589-594. [PMID: 36997289 PMCID: PMC10171392 DOI: 10.3174/ajnr.a7840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/04/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND PURPOSE Orbital compartment syndrome is a sight-threatening emergency caused by rising pressure inside the orbit. It is usually diagnosed clinically, but imaging might help when clinical findings are inconclusive. This study aimed to systematically evaluate imaging features of orbital compartment syndrome. MATERIALS AND METHODS This retrospective study included patients from 2 trauma centers. Proptosis, optic nerve length, posterior globe angle, morphology of the extraocular muscles, fracture patterns, active bleeding, and superior ophthalmic vein caliber were assessed on pretreatment CT. Etiology, clinical findings, and visual outcome were obtained from patient records. RESULTS Twenty-nine cases of orbital compartment syndrome were included; most were secondary to traumatic hematoma. Pathologies occurred in the extraconal space in all patients, whereas intraconal abnormalities occurred in 59% (17/29), and subperiosteal hematoma in 34% (10/29). We observed proptosis (affected orbit: mean, 24.4 [SD, 3.1] mm versus contralateral: 17.7 [SD, 3.1] mm; P < .01) as well as stretching of the optic nerve (mean, 32.0 [SD, 2.5] mm versus 25.8 [SD, 3.4] mm; P < .01). The posterior globe angle was decreased (mean, 128.7° [SD, 18.9°] versus 146.9° [SD, 6.4°]; P < .01). In 69% (20/29), the superior ophthalmic was vein smaller in the affected orbit. No significant differences were detected regarding the size and shape of extraocular muscles. CONCLUSIONS Orbital compartment syndrome is characterized by proptosis and optic nerve stretching. In some cases, the posterior globe is deformed. Orbital compartment syndrome can be caused by an expanding pathology anywhere within the orbit with or without direct contact to the optic nerve, confirming the pathophysiologic concept of a compartment mechanism.
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Affiliation(s)
- C Maier
- From the Departments of Radiology (C.M., N.T., N.L.B., T.C.W.-R.)
- Department of Radiology (C.M.), Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, New York
| | - N Thieme
- From the Departments of Radiology (C.M., N.T., N.L.B., T.C.W.-R.)
| | - B Beck-Broichsitter
- Oral and Maxillofacial Surgery (B.B.-B., M.H., K.K., S.K., J.O.V.)
- Department of Oral and Maxillofacial Surgery (B.B.-B.), Katharinenhospital Stuttgart, Stuttgart, Germany
| | - N L Beetz
- From the Departments of Radiology (C.M., N.T., N.L.B., T.C.W.-R.)
| | | | - K Rubarth
- Institute of Biometry and Clinical Epidemiology (K.R.), Charite-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (K.R., J.O.V.), Berlin, Germany
| | - M Heiland
- Oral and Maxillofacial Surgery (B.B.-B., M.H., K.K., S.K., J.O.V.)
| | - K Kreutzer
- Oral and Maxillofacial Surgery (B.B.-B., M.H., K.K., S.K., J.O.V.)
| | - S Koerdt
- Oral and Maxillofacial Surgery (B.B.-B., M.H., K.K., S.K., J.O.V.)
| | - J O Voss
- Oral and Maxillofacial Surgery (B.B.-B., M.H., K.K., S.K., J.O.V.)
- Berlin Institute of Health (K.R., J.O.V.), Berlin, Germany
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Papadiochos I, Petsinis V, Sarivalasis SE, Strantzias P, Bourazani M, Goutzanis L, Tampouris A. Acute orbital compartment syndrome due to traumatic hemorrhage: 4-year case series and relevant literature review with emphasis on its management. Oral Maxillofac Surg 2023; 27:101-116. [PMID: 35083570 DOI: 10.1007/s10006-021-01036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Blindness in craniomaxillofacial (CMF) injuries may occur due to acute orbital compartment syndrome (AOCS). Primarily, this article aimed to retrospectively review our 4-year experience in the management of patients diagnosed with AOCS secondary to an orbital hematoma (OH). Furthermore, this paper included up-to-date information regarding the prevalence, diagnosis, management, and prognosis of AOCS. MATERIALS AND METHODS We retrospectively screened the medical records of patients who visited our hospital's emergency department (ED) and were examined by an oromaxillofacial surgeon for CMF injuries, between September 1, 2013, and September 31, 2017. The electronic hospital's database was searched to retrieve all cases of CMF trauma admitted or referred to our clinic during this period. RESULTS Over a 49-month period, 3,514 patients were managed for CMF injuries in ED; 9 cases (0.26%) were attributed to OCS caused by an OH. This group comprised 5 males and 4 females aged between 32 and 91 years old (mean 65.7, median 70). Seven out of 9 patients were subjected to lateral canthotomy and inferior cantholysis (LCIC), whereas septolysis was applied in 6 of them. Sight was preserved in 3 out of 8 patients (37.5%), since a patient died from a serious intracranial injury. Seven out of 9 patients (77.7%) of the OCS group had a history of hypocoagulable state. CONCLUSIONS LCIC, septolysis, and careful dissection within inferotemporal orbital quadrant constitute a reliable approach for emergent orbital decompression. CT scan offers differential diagnosis of acute traumatic proptosis, but it should preferably follow LCIC. In case of OHs without pupillary abnormalities and/or impairment of visual acuity, close monitoring allowing for timely interventions is highly recommended to patients with a history of hypocoagulative status, (uncontrolled or severe) hypertension, head trauma, and decreased level of consciousness or in elderly patients suffering from dementia or without rapid access to follow-up medical care. Clinicians dealing with ED services must maintain high skills in AOCS diagnosis and in LCIC execution.
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Affiliation(s)
- Ioannis Papadiochos
- Attikon" University General Hospital, Chaidari, Medical School of Athens, Athens, Greece.
| | - Vasileios Petsinis
- School of Dentistry, Athens, Greece
- OMFS Clinic of "Evaggelismos" Gereral Hospital, Athens, Greece
| | | | - Paschalis Strantzias
- OMFS Clinic of "Panagiotis and Aglaia Kyriakou" Children's Hospital of Athens, Athens, Greece
| | | | - Lampros Goutzanis
- School of Dentistry, Athens, Greece
- OMFS Clinic of "Panagiotis and Aglaia Kyriakou" Children's Hospital of Athens, Athens, Greece
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Enz TJ, Tschopp M. Assessment of Orbital Compartment Pressure: A Comprehensive Review. Diagnostics (Basel) 2022; 12:diagnostics12061481. [PMID: 35741290 PMCID: PMC9221953 DOI: 10.3390/diagnostics12061481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
The orbit is a closed compartment defined by the orbital bones and the orbital septum. Some diseases of the orbit and the optic nerve are associated with an increased orbital compartment pressure (OCP), e.g., retrobulbar hemorrhage or thyroid eye disease. Our aim was to review the literature on the different approaches to assess OCP. Historically, an assessment of the tissue resistance provoked by the retropulsion of the eye bulb was the method of choice for estimating OCP, either by digital palpation or with specifically designed devices. We found a total of 20 articles reporting direct OCP measurement in animals, cadavers and humans. In nine studies, OCP was directly measured in humans, of which five used a minimally invasive approach. Two groups used experimental/custom devices, whilst the others applied commercially available devices commonly used for monitoring the compartment syndromes of the limbs. None of the nine articles on direct OCP measurements in humans reported complications. Today, OCP is mainly estimated using clinical findings considered surrogates, e.g., elevated intraocular pressure or proptosis. These diagnostic markers appear to reliably indicate elevated OCP. However, particularly minimally invasive approaches show promises for direct OCP measurements. In the future, more sophisticated, specifically designed equipment might allow for even better and safer measurements and hence facilitate the diagnosis and monitoring of orbital diseases.
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Affiliation(s)
- Tim J. Enz
- Department of Ophthalmology, University of Basel, CH-4031 Basel, Switzerland
- Lenzburg Eye Clinic, CH-5600 Lenzburg, Switzerland
- Correspondence:
| | - Markus Tschopp
- Department of Ophthalmology, Cantonal Hospital Aarau, CH-5001 Aarau, Switzerland;
- Department of Ophthalmology, Inselspital, University of Bern, CH-3010 Bern, Switzerland
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Epstein D, Safuri S, Socea S, Naaman E, Bar-Lavie Y. Severely Elevated Intraocular Pressure Following Traumatic Asphyxia: A Case Report. J Emerg Med 2022; 62:e95-e97. [PMID: 35400509 DOI: 10.1016/j.jemermed.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Traumatic asphyxia is a syndrome caused by a sudden pressure rise in the chest caused by crushing injury of the thorax or upper abdomen. It is associated with a variety of thoracic injuries, neurological symptoms, and ocular complications. CASE REPORT We report an unusual case of traumatic asphyxia complicated by severe, sight-threatening, elevation in intraocular pressure. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: After initial stabilization, the treatment of patients with traumatic asphyxia is supportive and is mainly directed toward the accompanying injuries and complications. A complete and prompt ophthalmologic examination, including tonometry, should be an integral part of the secondary survey. This is particularly important in patients who cannot report visual impairment, such as children or unconscious patients.
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Affiliation(s)
- Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Shadi Safuri
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Sergiu Socea
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Efrat Naaman
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Yaron Bar-Lavie
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Enz TJ, Papazoglou A, Tappeiner C, Menke MN, Benitez BK, Tschopp M. Minimally invasive measurement of orbital compartment pressure and implications for orbital compartment syndrome: a pilot study. Graefes Arch Clin Exp Ophthalmol 2021; 259:3413-3419. [PMID: 34097110 DOI: 10.1007/s00417-021-05222-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Diagnosis of orbital compartment syndrome is mainly based on clinical findings, such as intraocular pressure and proptosis, which try to estimate the orbital compartment pressure. However, the reliability of these surrogates is unclear. Current techniques for the direct measurement of orbital compartment pressure are widely experimental and impractical in the clinical setting. Our aim was to explore the feasibility of minimally invasive needle manometry for direct measurement of orbital compartment pressure under reproducible conditions in an in vivo model of orbital congestion. We further sought to evaluate intraocular pressure and proptosis as indicators for elevated orbital compartment pressure. METHODS A total of 7 ml of mepivacaine 2% solution was injected into the orbital compartment in 20 patients undergoing cataract surgery under local anesthesia. A commercially available single-use manometer device was inserted between the syringe and the injection needle to measure the orbital compartment pressure for each milliliter of intraorbital volume increment. Additionally, intraocular pressure (subgroup A; n = 10) or axial globe position (subgroup B; n = 10) were measured. RESULTS Needle manometry allowed for rapid and continuous measurement of orbital compartment pressure. Overall mean orbital compartment pressure increased from 2.5 mmHg pre- to 12.8 mmHg post-interventionally. Both, intraocular pressure (Spearman's correlation coefficient rs = 0.637, p < 0.0001) and proptosis (rs = 0.675, p < 0.0001) correlated strongly with the orbital compartment pressure. CONCLUSIONS Needle manometry appears to be a feasible minimally invasive instrument to directly measure orbital compartment pressure, showing promises for a more routine application in managing orbital compartment syndrome. The results further suggest that both elevated intraocular pressure and proptosis are valuable indicators for orbital compartment syndrome.
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Affiliation(s)
- Tim J Enz
- Department of Ophthalmology, Cantonal Hospital Aarau, 5000, Aarau, Switzerland. .,Department of Clinical Neuroscience, Section of Ophthalmology and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Anthia Papazoglou
- Department of Ophthalmology, Cantonal Hospital Aarau, 5000, Aarau, Switzerland
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel N Menke
- Department of Ophthalmology, Cantonal Hospital Aarau, 5000, Aarau, Switzerland.,Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benito K Benitez
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Markus Tschopp
- Department of Ophthalmology, Cantonal Hospital Aarau, 5000, Aarau, Switzerland. .,Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Ocular Related Sports Injuries. J Craniofac Surg 2021; 32:1606-1611. [PMID: 33741878 DOI: 10.1097/scs.0000000000007618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
ABSTRACT Ocular injuries occur frequently in sports, affecting the globe, surrounding soft tissues, and the orbital bony structure. This review provides the craniofacial surgeon a broad general overview of epidemiology, mechanism of disease, and prevention.
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Riekert M, Schick VC, Schumacher L, Zöller JE, Kreppel M, Schick T. Volumetric Analysis and Clinical Outcome in 54 Patients with Retrobulbar Hematoma. J Oral Maxillofac Surg 2021; 79:1914-1920. [PMID: 34153252 DOI: 10.1016/j.joms.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Retrobulbar hematoma (RBH) is a rare but serious vision threatening emergency. We analyze the relationship between hematoma volume, visual impairment and outcome. METHODS Fifty-four patients with RBH receiving orbital decompression were retrospectively included. Volumetric analysis of RBH was performed by semi-automatic segmentation based on preoperative CT scans using ITK-SNAP software. Best corrected visual acuity (BCVA) measurements were obtained and correlated in 2 groups (no light perception (NLP), severe visual impairment) with the hematoma volume. RESULTS NLP was documented preoperatively in 5/28 and postoperatively in 9/43 patients. Preoperative NLP was significantly associated with a larger hematoma volume (P = .03) and higher hematoma/orbital volume ratio (P = .03). Postoperative severe visual impairment showed significant associations with a larger hematoma volume (P = .02) as well as higher hematoma/orbital volume ratio (P = .02). CONCLUSION Eyes with severe visual impairment and large hematoma volumes preoperatively are at high risk of permanent vision loss. Hematoma volume calculation might represent an additional prognostic parameter for visual outcome after RBH.
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Affiliation(s)
- Maximilian Riekert
- Department of Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Volker C Schick
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Laura Schumacher
- Department of Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tina Schick
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; MVZ Augenärztliches Diagnostik- und Therapiecentrum Siegburg GmbH, Siegburg, Germany
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Mohamedbhai H, Butt A, Lee V, Perry MJ. Letter to Editor: Re: Erickson BP, Garcia GA. Evidence-based algorithm for the management of acute traumatic retrobulbar haemorrhage. Br J Oral Maxillofac Surg 2021; 59:850-851. [PMID: 33952403 DOI: 10.1016/j.bjoms.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- H Mohamedbhai
- Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ.
| | - A Butt
- Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ
| | - V Lee
- Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ
| | - M J Perry
- Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ
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Murali S, Davis C, McCrea MJ, Plewa MC. Orbital compartment syndrome: Pearls and pitfalls for the emergency physician. J Am Coll Emerg Physicians Open 2021; 2:e12372. [PMID: 33733246 PMCID: PMC7936795 DOI: 10.1002/emp2.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] 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.
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Affiliation(s)
- Shyam Murali
- Mercy Health St. Vincent Medical CenterToledoOhioUSA
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