title: Traumatic orbital compartment syndrome: importance of the lateral canthomy and cantholysis.
abstract: BACKGROUND
  Orbital compartment syndrome (OCS) is an ophthalmic emergency that requires urgent surgical decompression to preserve vision.
  
  
  OBJECTIVE
  To describe the clinical presentation, management and outcomes for patients with traumatic OCS.
  
  
  METHODS
  Retrospective case series of eight patients with OCS secondary to blunt trauma presenting to the Royal Adelaide Hospital between 2004 and 2013.
  
  
  RESULTS
  All patients had acute, painful decrease in visual acuity and proptosis. Common examination findings included a relative afferent pupillary defect, periorbital oedema, ophthalmoparesis and chemosis. All patients underwent surgical decompression in the form of a lateral canthotomy or cantholysis. Three patients who were decompressed within 2 h after injury recovered fully. One patient who sustained a macular hole at the time of injury recovered four lines of Snellen acuity after being decompressed within 1 h. Another patient recovered three lines of Snellen acuity after undergoing decompression at 2.5 h post-injury. The remaining patients had minimal visual recovery, with postoperative visual acuities ranging from hand movements to no perception to light. Of these patients, one was decompressed at 2 h, while the remaining underwent decompression at 4 and 6 h post-injury.
  
  
  CONCLUSIONS
  Prompt decompression is essential for visual recovery in OCS, which appears maximal if performed within 2 h of injury. All patients presenting with history and examination findings suggestive of OCS should undergo emergency canthotomy and cantholysis prior to any additional investigations to minimise visual loss.
authors.affiliation: Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology and Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Sun
authors.forename: Weng Onn
authors.initials: WO
authors.lastname: Chan
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014792:Visual Acuity; D014949:Wounds, Nonpenetrating / Q000150:complications*; D055815:Young Adult
keywords: orbital trauma; raised intraorbital pressure