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(a) The stages of Lateral canthotomy and inferior cantholysis procedure. Local anesthesia. (b) Clamping and hemostasis. (c) Incision on lateral canthus. (d) Cutting inferior crus of lateral canthal tendon.
Source publication
Orbital compartment syndrome (OCS) is one of a few true ophthalmologic emergencies. It develops due to acute intraorbital
pressure rising and if not immediately treated, the irreversible visual loss is unavoidable due to the damage to optic
disc and retina. Thus, the immediate diagnosis and management are vital for vision. In this review, we aimed...
Contexts in source publication
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... it exposes the LCT and enables to inferior cantholysis. Due to its dis- tant and lateral location from lacrimal system, LCT is a safe anatomic area for performing urgent orbital decompression. When performing the lateral canthotomy, amount in 1-2 cc of a local anesthetic (1% lidocaine with 1/100.000 adrena- line) into the skin on LCT is injected (Fig. 1a). Then, a tis- sue clamp is applied on this region for a half to one minute to crush providing the hemostatis of the area (Fig. 1b) (4,5,14). The area around the lateral canthus is cleaned using the irrigation with saline or chlorhexidine, and then draped. Sterile scissors are inserted carefully in the lateral palpebral terminal along ...
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... anatomic area for performing urgent orbital decompression. When performing the lateral canthotomy, amount in 1-2 cc of a local anesthetic (1% lidocaine with 1/100.000 adrena- line) into the skin on LCT is injected (Fig. 1a). Then, a tis- sue clamp is applied on this region for a half to one minute to crush providing the hemostatis of the area (Fig. 1b) (4,5,14). The area around the lateral canthus is cleaned using the irrigation with saline or chlorhexidine, and then draped. Sterile scissors are inserted carefully in the lateral palpebral terminal along the internal face of the lateral canthus. The incision on the skin and underlying eyelid tissue should be approximately 1 cm long ...
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... canthus is cleaned using the irrigation with saline or chlorhexidine, and then draped. Sterile scissors are inserted carefully in the lateral palpebral terminal along the internal face of the lateral canthus. The incision on the skin and underlying eyelid tissue should be approximately 1 cm long and be extended to the lateral bony orbital rim (Fig. 1c). However, a maxımum attention must be given while directing the scissors laterally and superficially to avoid iatrogenic injury to globe. Lateral canthotomy provides dividing of skin, fascial septum, orbicularis oculi muscle, and conjunctiva, presenting orbital fat tissue. Although LCT can be easily identified, lateral canthotomy ...
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... of the LCT is isolated with inferior retraction of the lower lid and attention is given to the direction of the tips of the scissors away from the globe. Anterior traction is placed on the free lateral edge of the lower lid and the inferior cruse of LCT can be identified as a taut band. Then, inferior crus of the LCT is cut with sharp scissors (Fig. 1d). At this moment, the fibrous tarsal plate of the lower lid relaxes. This step allows the significant decrease in the intra-orbital volume and even- tually decreases INOP. This results in a completely mobile lower lid. As the incision site will usually heal spontaneously, there is no need to the suturing. However, if an oculoplastic or ...
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... allows the significant decrease in the intra-orbital volume and even- tually decreases INOP. This results in a completely mobile lower lid. As the incision site will usually heal spontaneously, there is no need to the suturing. However, if an oculoplastic or cosmetic deformity occurs in lower lid, further surgical repair may be needed (14,15) (Fig. ...
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Well leg compartment syndrome (WLCS) is a rare complication which can occur following urological, gynecological, general surgical or orthopedic surgeries carried out with the lower limb in the hemilithotomy position. WLCS is associated with significant morbidity and mortality because delay in diagnosis and treatment can lead to loss of function and...
Citations
... Intraocular parameters refer to measurements taken within the eyeball, such as intraocular pressure, which should fall within the normal range of 10-21 mmHg for adult humans [17][18][19]. In contrast, intraorbital parameters refer to measurements taken within the orbit, such as IORP, which should fall within the normal range of 3-6 mmHg for adult humans [3,20,21]. In this animal study, we found an average initial IORP of 5.32 mmHg (first data point in Fig 2), while previous studies by Zoumalan et al. and Enz et al. reported mean orbital pressures of 4.1 mmHg and 2.5 mmHg, respectively [22,23]. ...
Intracranial pressure measurement is frequently used for diagnosis in neurocritical care but cannot always accurately predict neurological deterioration. Intracranial compliance plays a significant role in maintaining cerebral blood flow, cerebral perfusion pressure, and intracranial pressure. This study’s objective was to investigate the feasibility of transferring external pressure into the eye orbit in a large-animal model while maintaining a clinically acceptable pressure gradient between intraorbital and external pressures. The experimental system comprised a specifically designed pressure applicator that can be placed and tightly fastened onto the eye. A pressure chamber made from thin, elastic, non-allergenic film was attached to the lower part of the applicator and placed in contact with the eyelid and surrounding tissues of piglets’ eyeballs. External pressure was increased from 0 to 20 mmHg with steps of 1 mmHg, from 20 to 30 mmHg with steps of 2 mmHg, and from 30 to 50 mmHg with steps of 5 mmHg. An invasive pressure sensor was used to measure intraorbital pressure directly. An equation was derived from measured intraorbital and external pressures (intraorbital pressure = 0.82 × external pressure + 3.12) and demonstrated that external pressure can be linearly transferred to orbit tissues with a bias (systematic error) of 3.12 mmHg. This is close to the initial intraorbital pressure within the range of pressures tested. We determined the relationship between intraorbital compliance and externally applied pressure. Our findings indicate that intraorbital compliance can be controlled across a wide range of 1.55 to 0.15 ml/mmHg. We observed that external pressure transfer into the orbit can be achieved while maintaining a clinically acceptable pressure gradient between intraorbital and external pressures.
... -Surgical intervention: In severe cases with significant visual impairment or uncontrolled bleeding, surgical decompression of the orbit may be necessary. This can involve lateral canthotomy (incision of the outer corner of the eye) and cantholysis (release of the eyelid tendon) to alleviate pressure [30,31]. ...
... Prompt recognition and timely intervention are crucial in managing orbital hemorrhage during ESS to prevent long-term visual sequelae and optimize outcomes [30][31][32]. ...
Endoscopic sinus surgery (ESS) is a commonly performed procedure for the management of chronic rhinosinusitis and various sinonasal pathologies. While ESS offers significant benefits regarding improved sinonasal ventilation and reduced disease burden, it has risks. Ophthalmological complications during ESS are relatively rare but can have severe consequences. This review aims to provide a comprehensive overview of the ophthalmological complications associated with ESS, their pathophysiology, clinical manifestations, risk factors, prevention strategies, and management options. Though rare, ophthalmological complications during endoscopic sinus surgery can lead to significant morbidity if not promptly recognized and managed. Surgeons should be aware of the potential risks and strive to minimize them through meticulous surgical technique, preoperative evaluation, and appropriate postoperative care. Continued research and technological advancements are essential to enhance patient safety further and optimize ESS outcomes.
... Orbital compartment syndrome (OCS) is a sight-threatening emergency, immediate recognition and intervention is time critical as any delay can lead to visual impairment and even blindness. (3) This interesting case study highlights the importance of ED clinicians being trained to initiate time critical procedures like lateral canthotomies. ...
Lateral canthotomy was successfully done by an ED clinician
which proved to be effective in saving this patient’s vision.
... Posterior ischemia that affects the function of the optic nerve and the retina can cause irreversible visual loss. 1,2 Angioedema (AE) is a clinical entity defined as a selflimited edema located in the deeper layers of the skin and mucous membranes that lasts for several days. The disease was first described by Heinrich Quincke in 1882 and, since then, has been called Quincke's edema. ...
... Orbital compartment syndrome (OCS) is an ophthalmological emergency that occurs as a result of an acute or subacute increase in intraorbital pressure and, if not treated immediately, it leads to irreversible vision loss due to optic nerve ischemia. 1,2 The orbit constitutes a closed space, limited by the orbital septum and the tarsal plates of the eyelids, with a limited capacity to expand. Intraorbital pressure is 3 to 6 mmHg and if it increases suddenly for more than 60 to 100 minutes, permanent vision loss can occur. ...
... This loss may be due to multiples causes of ischemia, such as central retinal artery occlusion (CRAO), ischemic optic neuropathy, or as a result of direct compressive optic neuropathy. 1,2 Among the signs and symptoms that should lead to the suspicion of OCS are periorbital edema, resistance to retropulsion of the eyeball, proptosis, diminished visual acuity, diplopia, eye pain, limited eye movements, fixed mydriatic pupil or an afferent pupillary defect, increased intraocular pressure (IOP), and ecchymosis. In addition, if an ophthalmoscopy can be performed, optic disc edema, retinal venous congestion, pulsation in the central retinal artery or central retinal artery occlusion (CROA) may be observed. ...
A 68-year-old female presented with an episode of unilateral orbital compartment syndrome due to periorbital angioedema. The patient made a consultation at the general Emergency Room with sudden left periorbital edema and serious diminished ipsilateral visual acuity, with examination detecting orbital compartment syndrome secondary to a probable allergic angioedema after ingestion of ibuprofen. She received treatment with intravenous and oral corticosteroids, achieving a rapid improvement in the condition and clinical follow-up was carried out, with evaluation of the peripapillary retinal nerve fiber layer thickness and computed perimetry. Periorbital angioedema due to ibuprofen can be a cause of orbital compartment syndrome whose diagnosis and treatment must be carried out urgently to prevent permanent visual impairment.
... The orbit typically holds a volume of 30 mL containing globe, fat, extraocular muscles, vessels, nerves, lacrimal gland, and lacrimal sac held within fascial compartments [1][2][3]. The volume itself is confined by the orbital wall, orbital septum, and tarsal plate and intraocular pressure (IOP) is normally 8-21 mmHg [3][4][5][6]. ...
... The orbit typically holds a volume of 30 mL containing globe, fat, extraocular muscles, vessels, nerves, lacrimal gland, and lacrimal sac held within fascial compartments [1][2][3]. The volume itself is confined by the orbital wall, orbital septum, and tarsal plate and intraocular pressure (IOP) is normally 8-21 mmHg [3][4][5][6]. Significant assault including but not limited to hemorrhage, abscess, tumor, orbital edema, or emphysema, or orbital cellulitis can lead to rapid rise in IOP >30 mmHg leading to ischemia and eventually irreversible vision loss [3,7,8]. Retinal ischemia for more than 90-120 minutes' leads to high risk for permanent blindness and therefore, must be addressed immediately without any delay due to imaging [6,8]. ...
... The volume itself is confined by the orbital wall, orbital septum, and tarsal plate and intraocular pressure (IOP) is normally 8-21 mmHg [3][4][5][6]. Significant assault including but not limited to hemorrhage, abscess, tumor, orbital edema, or emphysema, or orbital cellulitis can lead to rapid rise in IOP >30 mmHg leading to ischemia and eventually irreversible vision loss [3,7,8]. Retinal ischemia for more than 90-120 minutes' leads to high risk for permanent blindness and therefore, must be addressed immediately without any delay due to imaging [6,8]. ...
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.
Orbital compartment syndrome is a poorly understood complication of acute burns. The purpose of this systematic review is to summarize the literature describing orbital compartment syndrome in burn patients to provide greater detail on risk factors and guide management of this morbid condition. A systematic review of the PubMed, Embase, and Cochrane Library databases was performed in June 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using two validated scoring systems. After removing duplicates, 303 unique articles were reviewed and 8 met inclusion criteria. All publications were retrospective. Most studies considered intraocular pressure >30-40mmHg as diagnostic for orbital compartment syndrome. Sixty unique cases of orbital compartment syndrome were reported. Orbital compartment syndrome occurred most frequently within 24 hours post-burn. The mean total body surface area of burn was 58.7%; the mean 24-hour resuscitation volume was 6.01 cc/kg/%total burn surface area; and 86.5% of cases had periorbital burns. Surgical decompression always started with lateral canthotomy. When pressures were not immediately reduced, cantholysis was performed. Study quality per Median Newcastle Ottawa Scores ranged from 38.9% to 94.4% (median 66.7%). A precise threshold for surgical decompression of OCS remains conflicted; however, IOP>30-40mmHg warrants intervention. Burn surgeons/intensivists should be aware of the risk factors for this vision-threatening complication and act appropriately.
Injectable dermal fillers continue to increase in popularity in aesthetic medicine. Although rare, vision loss secondary to filler injections is a devastating complication associated with a poor visual prognosis. The mechanism for vision loss is thought to be related to retrograde embolization of the dermal filler from peripheral vessels in the face into the ophthalmic arterial system. Early recognition and prompt management are essential if vision is to be salvaged. The use of retrobulbar hyaluronidase is still contentious, however when administered by a specialist, this treatment gives the best chance at visual recovery and should be considered for all cases.
Introduction:
Orbital cellulitis is an uncommon but serious condition that carries with it a potential for significant morbidity.
Objective:
This review highlights the pearls and pitfalls of orbital cellulitis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
Discussion:
Orbital cellulitis refers to infection of the globe and surrounding soft tissues posterior to the orbital septum. Orbital cellulitis is typically caused by local spread from sinusitis but can also be caused by local trauma or dental infection. It is more common in pediatric patients compared to adults. Emergency clinicians should first assess for and manage other critical, sight-threatening complications such as orbital compartment syndrome (OCS). Following this assessment, a focused eye examination is necessary. Though orbital cellulitis is primarily a clinical diagnosis, computed tomography (CT) of the brain and orbits with and without contrast is critical for evaluation of complications such as abscess or intracranial extension. Magnetic resonance imaging (MRI) of the brain and orbits with and without contrast should be performed in cases of suspected orbital cellulitis in which CT is non-diagnostic. While point-of-care ultrasound (POCUS) may be useful in differentiating preseptal from orbital cellulitis, it cannot exclude intracranial extension of infection. Management includes early administration of broad-spectrum antibiotics and ophthalmology consultation. The use of steroids is controversial. In cases of intracranial extension of infection (e.g., cavernous sinus thrombosis, abscess, or meningitis), neurosurgery should be consulted.
Conclusion:
An understanding of orbital cellulitis can assist emergency clinicians in diagnosing and managing this sight-threatening infectious process.
