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Peisah RI, Ostrowski K. Emergency management of orbital compartment syndrome: Lateral canthotomy and cantholysis case series. Australas Emerg Care 2024:S2588-994X(24)00055-1. [PMID: 39341722 DOI: 10.1016/j.auec.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 09/19/2024] [Accepted: 09/23/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Orbital compartment syndrome (OCS) is considered a time critical condition that requires urgent surgical decompression to preserve vision. This study aims to evaluate the current clinical criteria for performing a lateral canthotomy and cantholysis (LCC) in the emergency management of suspected traumatic OCS. METHODS A retrospective audit of patients with suspected traumatic OCS presenting to an adult major trauma centre between January 1, 2017, and August 1, 2022, was performed. RESULTS 20 patients with traumatic OCS treated with a LCC were identified. Five patients satisfied the definitive clinical criteria for LCC. The remaining 15 patients received LCC based on secondary clinical findings, or computed tomography (CT) findings suggestive of OCS. 17 patients received non-contrast CT scanning prior to LCC. Of the nine patients noted to regain baseline or close to baseline vision, only one was decompressed within two hours of injury. CONCLUSION Despite OCS being a clinical diagnosis, the signs and symptoms associated with OCS are difficult to elicit on presentation. Seeking imaging should not delay time to decompression when clinical diagnostic criteria are present. However, imaging may have a role in determining the need for orbital decompression where the absolute indications for LCC cannot be adequately assessed.
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Affiliation(s)
- Rebecca Ilona Peisah
- University of Notre Dame, St Vincent's Clinical School, Darlinghurst, NSW, Australia
| | - Kevin Ostrowski
- University of Notre Dame, St Vincent's Clinical School, Darlinghurst, NSW, Australia; Department of Emergency Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; CareFlight Ltd, Sydney, NSW, Australia.
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2
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Scoville NM, Ding L, Stacey AW. Success rates of lateral canthotomy and cantholysis for treatment of orbital compartment syndrome. Am J Emerg Med 2023; 70:140-143. [PMID: 37290250 DOI: 10.1016/j.ajem.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE Vision loss after facial trauma can occur from orbital compartment syndrome (OCS). Orbital compartment syndrome is commonly treated surgically with a lateral canthotomy and cantholysis (C&C). Our study investigates success rates of lateral C&C for the treatment of OCS amongst emergency medicine (EM) and ophthalmology providers. METHODS A retrospective cohort study was performed. Cases were identified and the electronic medical record of patients was interrogated for clinical and procedural information. Success of a lateral C&C was defined as a decrease in intraocular pressure (IOP) to <30 mmHg after the first attempt at the procedure. Inclusion criteria included documentation of a procedural attempt, a pre-procedure IOP >30 mmHg and a post-procedure IOP measurement; or alternatively if no pre-procedure IOP was documented but the IOP was >30 on arrival to the level 1 trauma center. Exclusion criteria included periprocedural use of ocular hypotensive medications and comorbid hyphema. RESULTS The final analysis included 74 eyes from 64 patients. Emergency medicine providers performed the initial lateral C&C in 68% of cases compared to 32% by ophthalmologists, and success rates were comparable - 68% vs 79.2%, respectively (p = 0.413). Poorer visual outcomes were associated with the initial failure of a lateral C&C and head trauma without an orbital fracture. All patients treated with a vertical lid split procedure met the criteria for 'success' as defined by this study. CONCLUSIONS The success rate of a lateral C&C is comparable amongst EM and ophthalmology providers. Improved training of physicians on the lateral C&C or other simpler procedures, such as the vertical lid split, could improve outcomes in OCS.
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Affiliation(s)
- N Maxwell Scoville
- Department of Ophthalmology, University of Washington, 908 Jefferson St Building, 7th Floor, Seattle, WA 98104, United States of America.
| | - Leona Ding
- Department of Ophthalmology, University of Washington, 908 Jefferson St Building, 7th Floor, Seattle, WA 98104, United States of America
| | - Andrew W Stacey
- Department of Ophthalmology, University of Washington, 908 Jefferson St Building, 7th Floor, Seattle, WA 98104, United States of America
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3
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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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4
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The Big Five—Lifesaving Procedures in the Trauma Bay. Emerg Med Clin North Am 2023; 41:161-182. [DOI: 10.1016/j.emc.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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5
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Fridie L, Michael Tzizik D. Traumatic Injuries of the Eye, Ear, Nose, and Throat. PHYSICIAN ASSISTANT CLINICS 2023. [DOI: 10.1016/j.cpha.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Wiser K, Weatherford T. Fall from bed resulting in emergent lateral orbital canthotomy…7 days later. Am J Emerg Med 2022; 60:225.e1-225.e4. [PMID: 35817644 DOI: 10.1016/j.ajem.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Orbital compartment syndrome is an ophthalmologic emergency that requires immediate intervention to preserve eyesight. This case highlights a rare, delayed presentation of orbital compartment syndrome requiring emergent lateral orbital canthotomy.
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Affiliation(s)
- Kyle Wiser
- Arnold Palmer Hospital for Children, Orlando, FL, USA.
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7
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Zogheib S, Sukkarieh G, Mjaess G, Zeid SA. Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic Review. Facial Plast Surg 2021; 38:274-278. [PMID: 34905802 DOI: 10.1055/s-0041-1740290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Orbital compartment syndrome (OCS) is an emergency that complicates intra-orbital, retrobulbar hemorrhage in most cases. Bony orbital decompression is an effective treatment for OCS, and displaced orbital fractures are protective. Nevertheless, in rare cases, OCS occurs despite a displaced orbital fracture. The aim of the current review is to present its pathophysiology and management based on what is published in the medical literature, and our center's experience. A systematic review of literature was conducted through PubMed, Medline, Embase, and Cochrane from inception through February 2021. The following search query was used: "orbital fracture" and "trauma" and "orbital compartment syndrome." Studies tackling the pathophysiology and management of concurrent displaced orbital fracture with OCS were included and a cohort of patients was constituted. A cohort of 18 cases reported in the literature were included (49.3 ± 30.6 years, 50% M). Given that OCS occurs with or without orbital fracture, pathophysiology of OCS is mostly explained by the division of the orbital fat into many compartments, due to the presence of Koorneef's fibrous septa. Management of OCS in such circumstances consisted of inferior-lateral canthotomy and cantholysis in 50% of cases, subperiosteal drainage with myringotomy in 22.2% of cases, subperiosteal drainage in 16.7% of cases, and complete lateral cantholysis in 16.7% of cases. Two cases who presented to our tertiary care center were also added to this review. Physicians should be aware that OCS can occur even with displaced fractures of the orbital cavity. When clinical suspicion is present, an emergent management is needed.
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Affiliation(s)
- Serge Zogheib
- Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Georges Sukkarieh
- Department of Ophthalmology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Georges Mjaess
- Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Samer Abou Zeid
- Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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8
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Herrmann JW, Hamor RE, Plummer CE. Canine Retrobulbar Cellulitis and Abscessation in the Southeastern United States: A review of case management, diagnostic imaging, bacterial isolates, and susceptibility patterns. Vet Ophthalmol 2021; 24:326-335. [PMID: 34480390 DOI: 10.1111/vop.12882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe common bacterial organisms cultured from retrobulbar cellulitis and abscess lesions, in vitro susceptibility patterns, common diagnostic techniques utilized, etiologies encountered, and prevalence of blindness. ANIMALS STUDIED Thirty-eight dogs diagnosed with retrobulbar cellulitis or abscessation from 2007 to 2017. PROCEDURE For cases of orbital cellulitis or abscess, signalment, orbital imaging, cytology, histopathology, bacterial culture and susceptibility testing, presence of vision at the initial examination and resolution, and presumed cellulitis/abscess etiology were recorded. RESULTS Most cases were medically (78.9%) versus surgically managed (18.4%). Most common form of orbital imaging was computed tomography (48.5%) followed by ocular ultrasound (18.2%). Fifteen of eighteen cultures (83.3%) showed growth of aerobic bacterial organisms, anaerobic bacterial organisms, or both. Most common aerobic bacteria were gram-negative bacilli (40.0%) followed by Corynebacterium sp. (26.7%) and α-hemolytic Streptococci sp. (26.7%) but Micrococcus and Bacillus spp. were also identified. Most common anaerobic bacteria were gram-negative bacilli (40.0%). Antibiotics with highest susceptibility patterns included gentamicin, followed equally by amoxicillin/clavulanic acid, cephalothin, chloramphenicol, and imipenem. No bacteria were susceptible to cefovecin. Six cases presented with vision loss due to retrobulbar disease (15.8%). Idiopathic (50%) disease and tooth root abscessation (23.7%) were most commonly diagnosed cause of orbital disease. CONCLUSION Retrobulbar cellulitis/abscess is a serious and vision-threatening process, which can be effectively managed by broad-spectrum antibiotics such as gentamicin or amoxicillin/clavulanic acid, but not cefovecin. This study identified three organisms that have not been previously reported to be associated with orbital cellulitis (Corynebacterium sp., Bacillus sp. and Micrococcus sp.).
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Affiliation(s)
- James W Herrmann
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Ralph E Hamor
- Large Animal Clinical Sciences, Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Caryn E Plummer
- Large Animal Clinical Sciences, Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
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Lim CS, Malick H, Berry-Brincat A. Emergency canthotomy and cantholysis - Factors affecting confidence among ophthalmic trainees in the United Kingdom. Indian J Ophthalmol 2021; 69:2385-2388. [PMID: 34427227 PMCID: PMC8544037 DOI: 10.4103/ijo.ijo_278_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Retrobulbar hemorrhage from trauma is the most common cause of orbital compartment syndrome. Emergency canthotomy and cantholysis is a vision-saving procedure. We sought to identify confidence among ophthalmic trainees in this procedure as well as any relevant factors that have any impact. Methods An online, confidential anonymous questionnaire was distributed to ophthalmology training groups in the UK. Questions explored the participant's stage of training and grade and confidence in this area as well as their ophthalmic experience in terms of training courses attended and elective versions of the procedure performed. Results We received 45 completed responses from the survey. 20/23 (87%) of junior trainees had not performed an emergency canthotomy/cantholysis to date, whereas 19/22 (86%) of senior trainees had performed between 1 and 5 such procedures. 15/23 (65%) of junior trainees had not performed an elective canthotomy compared to only 3/22 (14%) of the senior trainees. We found that the main factors that were associated with increased confidence level were the higher numbers of emergency and elective cases performed, training courses, and previous oculoplastic surgery rotation (P = 0.0001). Conclusion From our survey, we found low confidence levels among junior trainees due to limited exposure. Confidence appeared to be linked to both elective and emergency surgical experience of the procedure as well as training course and having worked in an oculoplastic surgery firm. Changes to training portfolio requirements for junior trainees to incorporate early oculoplastic experience may help to achieve this on a national scale.
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Affiliation(s)
- Christina S Lim
- Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Huzaifa Malick
- Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Antonella Berry-Brincat
- Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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10
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Kushwaha R, Agil J, Furiato A, Webb McAdams AL. Case of Orbital Compartment Syndrome Post Cardiac Arrest. Cureus 2021; 13:e16514. [PMID: 34430128 PMCID: PMC8375638 DOI: 10.7759/cureus.16514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/12/2022] Open
Abstract
Orbital compartment syndrome (OCS) is a rare ophthalmic surgical emergency in the setting of increased intraocular pressure (IOP) Irreversible vision loss can occur without immediate surgical treatment consisting of lateral cantholysis. We present a case of acute OCS discovered after cardiopulmonary resuscitation (CPR) with subsequent immediate lateral canthotomy and notable decrease in IOP. This in part demonstrates the importance of recognizing the clinical signs of OCS with or without trauma in the emergency department in addition with preparedness to perform a vision-saving procedure. Diagnosis is clinical and early recognition is essential. Index of suspicion for OCS in cardiac arrest without signs or history of trauma would typically be low, however, given the case presented, it was important for it to be excluded once the return of spontaneous circulation (ROSC) was achieved.
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Affiliation(s)
- Roli Kushwaha
- Emergency Medicine, Hospital Corporation of America West Florida Graduate Medical Education Consortium/Brandon Regional Hospital, University of South Florida Morsani College of Medicine, Brandon, USA
| | - Johnathan Agil
- Emergency Medicine, Hospital Corporation of America West Florida Graduate Medical Education Consortium/Brandon Regional Hospital, University of South Florida Morsani College of Medicine, Brandon, USA
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11
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Groombridge C, Maini A, Mathew J, O'Keeffe F, Noonan M, Smit DV, Fitzgerald M, Hall A. Orbital decompression. Emerg Med Australas 2021; 33:552-554. [PMID: 33709505 DOI: 10.1111/1742-6723.13768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
A trauma patient with orbital compartment syndrome may lose vision within hours of the injury. This article describes an approach to decompressing the orbit which may be sight-saving.
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Affiliation(s)
| | - Amit Maini
- National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Joseph Mathew
- National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Francis O'Keeffe
- National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Mike Noonan
- National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - De Villiers Smit
- National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Anthony Hall
- National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
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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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13
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Mendes M, Buchanan JA, Sande M, Moreira ME. An Easily Assembled, Low-Cost Model for Lateral Canthotomy Education. J Emerg Med 2021; 60:777-780. [PMID: 33593633 DOI: 10.1016/j.jemermed.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/23/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Lateral canthotomy is a vision-saving procedure. However, the low incidence of orbital compartment syndrome and the expense of simulators to practice this procedure can lead to low confidence and delays in the performance of the procedure by emergency physicians. DISCUSSION We used a simple, inexpensive, easily assembled eye model for lateral canthotomy education at a residency program and a national conference obtaining feedback from simulation participants. Residents rated procedure laboratories that included the lateral canthotomy model as 4.9 to 5 (on a 5-point Likert scale, with 5 being the best score). National conference participants rated the model a 9 as a useful training model for practitioners on a 10-point Likert scale. CONCLUSION This simple task trainer is practical, inexpensive, quickly assembled, and useful as a tool for practicing emergency medicine providers.
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Affiliation(s)
- Matthew Mendes
- Department of Emergency Medicine, Denver Health Residency in Emergency Medicine, Denver, Colorado
| | - Jennie A Buchanan
- Department of Emergency Medicine, Denver Health and Hospital Authority, University of Colorado School of Medicine, Denver, Colorado
| | - Margaret Sande
- Department of Emergency Medicine, University of Virginia, Charlottesville, Virginia
| | - Maria E Moreira
- Department of Emergency Medicine, Denver Health and Hospital Authority, University of Colorado School of Medicine, Denver, Colorado
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Coccolini F, Improta M, Picetti E, Vergano LB, Catena F, de ’Angelis N, Bertolucci A, Kirkpatrick AW, Sartelli M, Fugazzola P, Tartaglia D, Chiarugi M. Timing of surgical intervention for compartment syndrome in different body region: systematic review of the literature. World J Emerg Surg 2020; 15:60. [PMID: 33087153 PMCID: PMC7579897 DOI: 10.1186/s13017-020-00339-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 12/28/2022] Open
Abstract
Compartment syndrome can occur in many body regions and may range from homeostasis asymptomatic alterations to severe, life-threatening conditions. Surgical intervention to decompress affected organs or area of the body is often the only effective treatment, although evidences to assess the best timing of intervention are lacking. Present paper systematically reviewed the literature stratifying timings according to the compartmental syndromes which may beneficiate from immediate, early, delayed, or prophylactic surgical decompression. Timing of decompression have been stratified into four categories: (1) immediate decompression for those compartmental syndromes whose missed therapy would rapidly lead to patient death or extreme disability, (2) early decompression with the time burden of 3-12 h and in any case before clinical signs of irreversible deterioration, (3) delayed decompression identified with decompression performed after 12 h or after signs of clinical deterioration has occurred, and (4) prophylactic decompression in those situations where high incidence of compartment syndrome is expected after a specific causative event.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Mario Improta
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | | | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Nicola de ’Angelis
- Unit of Digestive and Hepato-biliary-pancreatic Surgery, Henri Mondor Hospital and University Paris-Est Créteil (UPEC), Créteil, France
| | - Andrea Bertolucci
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Andrew W. Kirkpatrick
- Departments of Surgery and Critical Care Medicine, Foothills Medical Centre, Calgary, Canada
| | | | - Paola Fugazzola
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
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Abstract
Clinical evaluation of patients with trauma is challenging, especially in the presence of neurologic injuries. Vision loss after trauma is a harmful and usually overlooked consequence that may be avoided with a prompt and accurate intervention. Head CT is commonly performed in patients with trauma. However, radiologists may be unfamiliar with the CT findings associated with injuries that may affect eyesight. Understanding the visual pathway anatomy and its critical landmarks is paramount for recognizing these findings. This article describes the use of head CT to evaluate the visual pathway to help avoid vision loss in patients with trauma. Injuries are presented in terms of those affecting the globe (rupture, hemorrhage, and lens trauma), optic nerve (direct and indirect traumatic optic neuropathy), orbit (orbital compression syndrome), and vasculature (traumatic carotid-cavernous sinus fistula and posterior cerebral artery injury or ischemia). Techniques for measuring the globe on CT to assess for injury are illustrated. Indications for screening CTA of the head and neck in patients with suspicion for blunt traumatic vascular injury are summarized. Emphasis is placed on the CT findings that warrant an emergency intervention to prevent traumatic visual impairment.
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16
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Erstversorgung von Patienten mit Augenverletzungen. Notf Rett Med 2020. [DOI: 10.1007/s10049-020-00686-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Visual Outcomes of Patients With Retrobulbar Hemorrhage Undergoing Lateral Canthotomy and Cantholysis. Ophthalmic Plast Reconstr Surg 2020; 35:586-589. [PMID: 31693632 DOI: 10.1097/iop.0000000000001401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Evaluate visual outcomes in relation to time from injury to intervention in patients who undergo lateral canthotomy with cantholysis (LCC) for retrobulbar hemorrhage (RBH). METHODS Retrospective study of patients with orbital compartment syndrome (OCS) secondary to RBH who underwent LCC. OCS due to RBH was defined by a combination of decreased vision, proptosis, resistance to retropulsion, increased intraocular pressure, and relative afferent pupillary defect. Time from injury to intervention and change in visual acuity were calculated, with regression analysis identifying predictors of vision recovery. RESULTS Fifteen participants were included. Three (20%) participants presented with no light perception, 7 (47%) with count fingers (CF) to light perception, and 5 (33%) with better than count fingers vision. All 5 participants who had LCC within 3 hours (twice the standard 90 minutes) gained some vision, and 6 of 10 participants who had LCC after 3 hours recovered some vision. The latest intervention with visual acuity improvement was performed 9 hours postinjury. Of 3 participants who presented with no light perception vision, 1 regained vision to 20/40 (intervention 1.7 hours postinjury), and 2 did not regain any vision (interventions at 5 and 8.7 hours postinjury). Duration from injury to intervention was associated with decreased amount of vision recovery (P = 0.03). CONCLUSIONS Increased time to intervention with LCC was associated with less vision recovery after OCS from RBH. However, over half of participants with intervention more than 90 minutes after injury still showed visual acuity improvement. The authors recommend LCC in all patients who present with OCS regardless of the time since injury.Patients with orbital compartment syndrome may see visual recovery after lateral canthotomy and cantholysis, even if performed outside of the previously accepted 3-hour window.
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Lateral Canthotomy and Cantholysis in Operations Iraqi Freedom and Enduring Freedom: 2001-2011. Ophthalmic Plast Reconstr Surg 2019; 35:62-66. [PMID: 29979268 DOI: 10.1097/iop.0000000000001168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe outcomes and associated ocular injuries of lateral canthotomy and cantholysis (LCC) as performed in combat ocular trauma. METHODS Data from the Walter Reed Ocular Trauma Database of patients requiring LCC during Operations Iraqi Freedom and Enduring Freedom was reviewed as a retrospective cohort. Primary outcome measures included final visual acuity (VA) and Ocular Trauma Score. Secondary outcome measures were associated injuries and timing of surgery. RESULTS Thirty-six LCCs were recorded on a total of 890 eyes (4.04 %) in the Walter Reed Ocular Trauma Database. Eighteen out of 36 eyes (50.00%) had a final VA of the affected eye of 20/200 or worse vision. From the initial available VA measured either at the time of injury or at Walter Reed Army Medical Center, 13 eyes (40.63%) had no change in VA, 15 eyes (46.88%) had improvement, and 4 (12.5%) had a decrease in VA (n = 32, data unavailable for 4 eyes). Ocular Trauma score 0-65 was noted in 14 (38.9%) and 66-100 (61.1%). Retinal detachment (6, 16.67%), optic nerve injuries (7, 19.44%), orbital fractures (20, 55.56%), and retrobulbar hematoma (25, 69.44%) were commonly associated injuries. Of the 36 LCC, 18 (50.00%) were performed as the first surgery performed at the combat support hospital, 13 (36.11%) as the second, 4 (11.11%) as the third, and 1 (2.78%) as the fourth. CONCLUSIONS The largest subgroup of patients had an improvement in VA associated with performance of LCC; however, half of patients remained with a final VA of equal to or worse than 20/200 due to severe ocular trauma.
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Visual outcomes after traumatic retrobulbar hemorrhage are not related to time or intraocular pressure. Am J Emerg Med 2019; 38:2308-2312. [PMID: 31784392 DOI: 10.1016/j.ajem.2019.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The paucity of literature regarding the role of time and intraocular pressure (IOP) when treating ocular compartment syndrome (OCS) has resulted in limited guidance for emergency physicians (EP). OBJECTIVES Our goals were to investigate the ideal time frame for lateral canthotomy, to understand the relationship between IOP and visual outcome, and to determine the impact of EP performance on visual acuity (VA). METHODS The study population included patients presenting over an 18-year period with traumatic retrobulbar hemorrhage (RBH) treated with lateral canthotomy. Efficacy was evaluated using visual outcome and IOP. Patients were grouped by time from injury and arrival to canthotomy. Procedures completed in the emergency department (ED) and by EPs were evaluated regarding visual outcome. RESULTS Sixty cases of RBH treated with lateral canthotomy were identified. Over two-thirds (43/60, 71.7%) were discharged with baseline vision. Lateral canthotomy lowered IOP from a median of 50.0 mmHg (IQR: 40.5, 61) preprocedure to 23.0 mmHg (IQR: 18, 27) post-procedure (p-value = 0.000001). No correlation was found between time, IOP, location, specialty of clinician, and visual outcome. CONCLUSION Lateral canthotomy is an effective at lowering IOP. Our data suggest that using time and IOP to predict procedural outcome is flawed. If OCS is suspected, lateral canthotomy should be considered and can be effectively performed by EPs. Neither the time of injury to ED presentation nor degree of IOP elevation should be factored into the decision of when to perform the procedure.
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McCallum E, Keren S, Lapira M, Norris JH. Orbital Compartment Syndrome: An Update With Review Of The Literature. Clin Ophthalmol 2019; 13:2189-2194. [PMID: 31806931 PMCID: PMC6844234 DOI: 10.2147/opth.s180058] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/03/2019] [Indexed: 12/30/2022] Open
Abstract
Orbital compartment syndrome (OCS) is a potentially blinding condition characterized by a rapid increase in intra-orbital pressure. OCS is most commonly seen in the context of intra-orbital hemorrhage secondary to either trauma or surgery. A review of the literature indicates that better visual outcomes are achieved when interventions occur within the first 2 hrs. There are reports of visual recovery after a delay in management and consideration should be given to intervention even when presentation is delayed. Reported interventions include: lateral canthotomy with cantholysis, bony orbital decompression and treatment of the underlying cause.
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Affiliation(s)
- Ewan McCallum
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Shay Keren
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Matthew Lapira
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
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Berg BI, Flury E, Thieringer FM, Augello M, Savic M, Schötzau A, Kunz C, Goldblum D. Retrobulbar haematoma in the era of anticoagulants. Injury 2019; 50:1641-1648. [PMID: 31519435 DOI: 10.1016/j.injury.2019.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 02/02/2023]
Abstract
AIM The present retrospective study aimed to evaluate the frequency and distribution of retrobulbar haematoma (RBH) among 26 patients (12 male/14 female) who had suffered maxillofacial trauma/surgery, with special focus on anticoagulants, causes of accidents, treatment, and outcome. METHODS Patient ages ranged from 8 to 94 years, with a mean of 65 years. Among all patients, 43% had received anticoagulant therapy at admission; 92.3% had a previous history of maxillofacial trauma. RESULTS The most frequent cause of RBH were falls (65.4%), and three patients experienced RBH postoperatively after treatment using polydioxanone foil. Postoperatively (after RBH relief), 33.3% of the patients reported persistent complete visual loss; of these patients, 29% had received anticoagulation therapy, and the oral anticoagulant intake was not documented in further 29% of the patients. CONCLUSION Awareness of this pathologic process is crucial for preventing permanent loss of vision via early diagnosis and adequate therapy. With increasing age, patients are more likely to receive an anticoagulant, which leads to a higher risk of RBH. Because falling was the most frequent cause of RBH in our patient population and increases in frequency with increasing age, fall prevention is crucial.
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Affiliation(s)
- Britt-Isabelle Berg
- University Hospital Basel, Department of Oral and Cranio-Maxillofacial Surgery, Basel, Switzerland
| | - Emanuel Flury
- University Hospital Basel, Department of Oral and Cranio-Maxillofacial Surgery, Basel, Switzerland
| | - Florian M Thieringer
- University Hospital Basel, Department of Oral and Cranio-Maxillofacial Surgery, Basel, Switzerland; Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Marcello Augello
- Department of Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Miodrag Savic
- University Hospital Basel, Department of Oral and Cranio-Maxillofacial Surgery, Basel, Switzerland; Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Andreas Schötzau
- Department of Ophthalmology, University Hospital of Basel and University of Basel, Basel, Switzerland
| | - Christoph Kunz
- University Hospital Basel, Department of Oral and Cranio-Maxillofacial Surgery, Basel, Switzerland
| | - David Goldblum
- Department of Ophthalmology, University Hospital of Basel and University of Basel, Basel, Switzerland
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Herder PAP, Lu MM, LaPorta AJ, Ross DW, Calvano CJ, Enzenauer RW. Comparison of a Novel Trainer to a Traditional Swine Model for Training Providers in Lateral Canthotomy and Cantholysis. Mil Med 2019; 184:342-346. [PMID: 30901413 DOI: 10.1093/milmed/usy389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/09/2018] [Indexed: 11/14/2022] Open
Abstract
RESEARCH OBJECTIVE Military personnel are at greater risks of head and facial traumas and permanent blindness from orbital compartment syndrome in modern warfare. Rapid treatment must be implemented with a low-risk surgical remedy: lateral canthotomy and cantholysis (LCC). Traditional training of LCC is primarily performed using an animal tissue trainer (ATT); however, limitations to these types of trainers exist. Therefore, our research objectives were focused on highlighting the effectiveness, benefits, and vision-saving potential of learning LCC on a synthetic trainer. METHODS Participants included 22 second-year medical students and 6 healthcare professionals. A pre-quiz assessed baseline knowledge. Next, an experienced ophthalmologist provided an overview and instruction. Subjects were randomized to either the synthetic trainer or the ATT and then switched to the other model for comparison. After performing LCC procedures on both models, a post-quiz and survey were administered. RESULTS Participants found the synthetic trainer easier to use than the ATT model (p < 0.01). There was no statistically significant preference (p = 0.23), or preference of practical eye anatomy (p = 0.26) between the trainers. Post-quiz results demonstrated an overall improvement from pre-quiz scores for participants (p < 0.001). CONCLUSIONS The synthetic trainer is comparable to the traditional swine model for training LCC procedures, and should be considered as a future training platform.
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Affiliation(s)
| | - Michelle M Lu
- Rocky Vista University College of Osteopathic Medicine, 8401 S. Chambers Rd, Parker, CO
| | - Anthony J LaPorta
- Rocky Vista University College of Osteopathic Medicine, 8401 S. Chambers Rd, Parker, CO
| | - David W Ross
- Rocky Vista University College of Osteopathic Medicine, 8401 S. Chambers Rd, Parker, CO
| | | | - Robert W Enzenauer
- University of Colorado Anschutz Medical Campus, 13001 E. 17th Pl, Aurora, CO
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Houck J, Mangal R, Vandillen C, Ganti L, Sleigh BC. Orbital Compartment Syndrome: How a Young Man's Vision was Saved by the Timely Actions of an Emergency Medicine Physician. Cureus 2019; 11:e5057. [PMID: 31516769 PMCID: PMC6721876 DOI: 10.7759/cureus.5057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In the following case presentation, a young man who incurred orbital compartment syndrome (OCS) from physical trauma significantly improved from timely lateral canthotomy. Lateral canthotomy is recommended to be performed as soon as possible to avoid permanent vision loss, which is the most feared complication associated with orbital compartment syndrome. This procedure completely restored vision in the patient and permitted prompt discharge.
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Affiliation(s)
- Jessica Houck
- Emergency Medicine, University of Central Florida College of Medicine / Hospital Corporation of America Graduate Medical Education (HCA GME) Consortium, Kissimmee, USA
| | - Rohan Mangal
- Emergency Medicine, John Hopkins University, Baltimore, USA
| | - Chrissy Vandillen
- Emergency Medicine, St. Cloud Regional Medical Center, St. Cloud, USA
| | - Latha Ganti
- Emergency Medicine, Envision Physician Services, Orlando, USA
| | - Bryan C Sleigh
- Emergency Medicine, Mercer University School of Medicine, Macon, USA
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Timlin H, Bell S, Uddin J, Osborne S. Treatment outcomes of lateral canthotomy and cantholysis for orbital compartment syndrome. Br J Oral Maxillofac Surg 2019; 57:488-490. [DOI: 10.1016/j.bjoms.2019.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
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Orbital Compartment Syndrome. BEYOGLU EYE JOURNAL 2019; 4:1-4. [PMID: 35187423 PMCID: PMC8842040 DOI: 10.14744/bej.2018.70288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/14/2018] [Indexed: 11/24/2022]
Abstract
Orbital compartment syndrome (OCS) is a true ophthalmological emergency. It develops as a result of an acute rise in intra-orbital pressure, and if not treated immediately, damage to the optic disc and retina will lead to irreversible vision loss. Thus, immediate diagnosis and management are vital to preserve vision. Presented here is a brief summary of OCS in order to call attention to this condition.
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Sauvage A, Bolen G, Monclin S, Grauwels M. Orbital compartment syndrome resulting in unilateral blindness in two dogs. Open Vet J 2018; 8:445-451. [PMID: 30538937 PMCID: PMC6258518 DOI: 10.4314/ovj.v8i4.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/25/2018] [Indexed: 12/11/2022] Open
Abstract
Orbital compartment syndrome (OCS) is described in humans as an acute rise in intraorbital pressure following a severe and rapidly evolving orbital affection. It includes orbital oedema, haemorrhage or infection causing a marked reduction in local blood perfusion, and severely affecting the orbital neurovascular structures. If not promptly recognised and treated, it results in irreversible blindness. It is one of the rare ophthalmic surgical emergencies, requiring lateral canthotomy and cantholysis. This case report describes two canine cases of complex orbital, periorbital and facial abscesses resulting in OCS and permanent unilateral blindness diagnosed by ultrasonography, computed tomography and electroretinography.
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Affiliation(s)
- Aurélie Sauvage
- Department of Clinical Sciences, Companion and Equine Animals, Ophthalmology, University of Liège, Quartier Vallée 2, Avenue de Cureghem 3, 4000 Liège, Belgium
| | - Géraldine Bolen
- Department of Clinical Sciences, Companion and Equine Animals, Diagnostic Imaging, University of Liège, Quartier Vallée 2, Avenue de Cureghem 3, 4000 Liège, Belgium
| | - Sébastien Monclin
- Department of Clinical Sciences, Companion and Equine Animals, Ophthalmology, University of Liège, Quartier Vallée 2, Avenue de Cureghem 3, 4000 Liège, Belgium
| | - Magda Grauwels
- Department of Clinical Sciences, Companion and Equine Animals, Ophthalmology, University of Liège, Quartier Vallée 2, Avenue de Cureghem 3, 4000 Liège, Belgium
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A Historical Perspective of Lateral Canthotomy and Its Adoption as an Emergency Medicine Procedure. J Emerg Med 2018; 56:46-52. [PMID: 30389285 DOI: 10.1016/j.jemermed.2018.09.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/23/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The treatment of orbital compartment syndrome has a rich history rooted in surgery and emergency medicine. It is a rare but acute and vision-threatening condition that most commonly occurs secondary to facial trauma or as a postoperative complication, and was first recognized in 1950. Surgical techniques and medical management were developed and refined soon afterwards to eventually become the modern-day treatment, lateral canthotomy, and inferior cantholysis. OBJECTIVE This article details the history of orbital compartment syndrome and the evolution of its treatment to the present day. DISCUSSION Given the time-sensitive nature and acuity of orbital compartment syndrome, lateral canthotomy was adopted by emergency physicians who could perform it more quickly at the bedside. CONCLUSIONS Lateral canthotomy is a procedure adopted by emergency physicians from the surgical literature. The history of its adoption is a representative example of how emergency medicine evolves as a field.
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Schwitkis AE, Pollack TL, Torbati SS. Orbital Compartment Syndrome Following Mechanical Fall. Clin Pract Cases Emerg Med 2018; 2:268-269. [PMID: 30083652 PMCID: PMC6075486 DOI: 10.5811/cpcem.2018.4.37810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Arielle E Schwitkis
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Talia L Pollack
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Sam S Torbati
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
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Amorim Correa JL, Acioly MA. The Enigma of Orbital Compartment Syndrome After Lumbar Spine Surgery in the Prone Position: Case Report and Literature Review. World Neurosurg 2018; 110:309-314. [DOI: 10.1016/j.wneu.2017.11.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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Gupta D, Beigi B. Orbital Compartment Syndrome despite Significant Traumatic Expansion of the Orbital Cavity. Craniomaxillofac Trauma Reconstr 2017; 10:239-243. [PMID: 28751950 DOI: 10.1055/s-0036-1592084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022] Open
Abstract
Periorbital injury can present with various permutations of bone trauma, soft-tissue edema, and hematomas that might involve proptosis and restricted motility. We report a case of a 32-year-old patient who sustained a traumatic orbital compartment syndrome simultaneously with a large, significantly displaced, orbital-floor blow-out fracture. Clinical signs consistent with both conditions were elicited. The initial management was as for orbital compartment syndrome. The clinical diagnosis was confirmed with computed tomographic imaging. This is an unusual and unexpected presentation. It would be expected that a hemorrhage would self-decompress in the presence of a large fracture. Physicians should be aware that such a combination of pathology might arise. Physicians likely to encounter periocular trauma should be prepared for its management: urgent lateral canthotomy and cantholysis. Differential diagnoses of periocular trauma are compared and contrasted.
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Affiliation(s)
- Deepak Gupta
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Bijan Beigi
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
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Abstract
Facial trauma varies widely in its severity and is also frequently associated with other injuries which can make prioritisation of injuries difficult. An effective method of triage is important to ensure this. This article describes one such approach and discusses the application of damage control principles to facial injuries. Both these issues commonly impact on the management of multiply injured patients with coexisting facial injuries during the initial stages of resuscitation or soon afterwards. Understanding facial trauma is based in part, on parallels with orthopaedic trauma.
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Affiliation(s)
- Mike Perry
- Consultant oral and maxillofacial surgeon, Northwick Park Hospital, UK
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Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
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See A, Gan EC. Orbital compartment syndrome during endoscopic drainage of subperiosteal orbital abscess. Am J Otolaryngol 2015; 36:828-31. [PMID: 26545481 DOI: 10.1016/j.amjoto.2015.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Orbital compartment syndrome is a rare ocular emergency requiring immediate intervention to prevent vision loss. It can arise due to a variety of causes including trauma, neoplasms and retrobulbar hemorrhage during endoscopic sinus surgery. Lateral canthotomy and inferior cantholysis is a well-known therapeutic procedure to rapidly relieve raised intraocular pressures. CASE REPORT We report a case of a subperiosteal orbital abscess due to acute maxillary sinusitis that underwent endoscopic drainage. Intraoperatively, he developed raised intraocular pressure following irrigation of the maxillary sinus and manual pressure on the malar abscess, necessitating emergent lateral canthotomy and inferior cantholysis. CONCLUSION To our knowledge, this is the first reported case of orbital compartment syndrome following sinonasal irrigation and malar pressure in the English literature. This case will serve as a reminder to the sinus surgeon of the potential danger of transmitted pressure from the paranasal sinus or malar soft tissue into the orbital compartment.
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Soare S, Foletti JM, Gallucci A, Collet C, Guyot L, Chossegros C. Update on orbital decompression as emergency treatment of traumatic blindness. J Craniomaxillofac Surg 2015; 43:1000-3. [DOI: 10.1016/j.jcms.2015.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/10/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022] Open
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