Orbital compartment syndrome is a sight-threatening emergency in which pressure within the bony eye socket rises rapidly, compressing the optic nerve and blood supply to the eye. It usually follows trauma, surgery, or bleeding behind the eye.
Causes and Features
The rigid bony walls of the orbit mean that any sudden increase in volume, such as from haemorrhage or severe swelling, can quickly raise pressure. People typically develop sudden pain, reduced vision, bulging of the eye, tight or hard eyelids, and limited eye movements.
- Most often related to blunt trauma, surgery, or bleeding disorders
- Can occur after orbital injections or severe orbital inflammation
- Visual loss may progress rapidly without intervention
- Prompt recognition is critical to prevent permanent damage
Management
Orbital compartment syndrome is managed as an emergency, with urgent decompression of the orbit to relieve pressure, often by performing a lateral canthotomy and cantholysis. Supportive care includes treating the underlying cause and monitoring vision and optic nerve function closely.
- Urgent ophthalmic and maxillofacial or oculoplastic input is usually required
- Delay in treatment increases the risk of irreversible optic nerve injury
- Systemic measures such as head elevation and medications may help lower pressure
- Follow-up assesses recovery of visual function and identifies any residual effects
