The "tight orbit": Incidence and management of the orbital compartment syndrome.
OBJECTIVE
The orbital compartment syndrome (OCS) constitutes a severe emergency, requiring immediate clinical diagnosis and surgical decompression. The key symptom is progressive visual impairment caused by an increase in intraorbital pressure, impairing the perfusion of relevant neurovascular and neurosensory structures. Intraorbital bleeding due to trauma and surgical intervention is known to be the main etiological factor.


METHODS
A retrospective analysis of all patients affected by an OCS between January 1, 2012, and May 31, 2015, was performed. Patients' records were reviewed with regard to etiology, initial ophthalmologic status, fracture pattern, concomitant medication, surgical management, and postoperative outcome. The incidence of OCS was calculated based on the total number of craniomaxillofacial (CMF) emergencies.


RESULTS
Within 3.5 years, a total of 18,093 CMF emergencies were registered. In 16 patients, an OCS was documented, corresponding to an incidence of 0.088%. The mean patient age was 67.31 ± 23.86 years, ranging from 22 to 102 years. The etiology varied, but trauma with subsequent intraorbital bleeding was the main cause. The use of anticoagulative medication was documented in 50% of the cases. In 14 patients, immediate surgical orbital decompression was performed: in 10 patients, vision could be preserved; in three patients, blindness resulted; and one patient was lost to follow-up. Two patients were managed without surgery.


CONCLUSIONS
With regard to the total number of CMF emergencies, OCS is a rare condition. Early clinical diagnosis and surgical decompression are required to prevent permanent vision impairment. Anticoagulative medication must be considered as a predisposing factor for an orbital compartment syndrome in patients affected by periorbital trauma.
Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: jan.voss@charite.de.
Jan Oliver
JO
Voss
Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: stefan.hartwig@charite.de.
Stefan
S
Hartwig
Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: christian.doll@charite.de.
Christian
C
Doll
Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: bodo.hoffmeister@charite.de.
Bodo
B
Hoffmeister
Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: jan-dirk.raguse@charite.de.
Jan-Dirk
JD
Raguse
Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. B. Hoffmeister), Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: nicolai.adolphs@charite.de.
Nicolai
N
Adolphs
D000328:Adult; D000369:Aged, 80 and over; D001604:Berlin / Q000453:epidemiology; D003161:Compartment Syndromes / Q000453:epidemiology / Q000601:surgery; D019299:Decompression, Surgical; D005151:Facial Injuries / Q000150:complications; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
Orbital compartment syndrome; Orbital decompression; Retrobulbar hemorrhage