title: Management of the 'tight orbit' and associated visual loss.
abstract: OBJECTIVE
  To review the most recent literature on the management of the orbit under high pressure (the tight orbit) with threatened visual loss.
  
  
  RESULTS
  Definitive management of traumatic optic neuropathy remains unclear, lacking randomized head-to-head treatment option trials. Instead, numerous case series and anecdotal reports show benefit in each of the four treatment modalities currently in use, but a multitude of variables confound cross-study comparison. In contrast, the management of orbital hemorrhage and orbital emphysema is well known. A number of immunomodulatory protocols have recently arisen for the medical suppression of Graves' ophthalmopathy, but when surgical decompression is required, most authors currently favor a combined transconjunctival and endoscopic endonasal approach.
  
  
  CONCLUSIONS
  This article reviews the anatomy, pathophysiology, diagnosis, and intervention of the 'tight orbit' with associated visual loss. Guidelines for the intervention are given.
authors.affiliation: Alford Facial Plastic Surgery, The Methodist Hospital, Houston, Texas 77030, USA. Ealford@tmhs.org
authors.forename: Eugene L
authors.initials: EL
authors.lastname: Alford
authors.forename: Charles N S
authors.initials: CN
authors.lastname: Soparkar
mesh_terms: D019299:Decompression, Surgical / Q000379:methods; D004646:Emphysema / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005130:Eye Hemorrhage / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014786:Vision Disorders / Q000517:prevention & control*