Bony Orbital Decompression Following Lateral Canthotomy and Cantholysis for Traumatic Orbital Compartment Syndrome

Abstract

Purpose: To describe the clinical course of patients with traumatic orbital compartment syndrome who underwent bony orbital decompression due to persistently abnormal pupillary light reflex after lateral canthotomy and cantholysis. Methods: Four consecutive patients were retrospectively reviewed. The authors performed bony orbital decompression as there was no improvement in the pupillary light reflex and a tight orbit persisted even after lateral canthotomy and cantholysis. Results: The median interval between injury and bony decompression was 8.8\u200ahours (range, 7–12\u200ahours). All patients showed a preoperative intraocular pressure of 40 mm Hg or greater, which decreased to 20 mm Hg or less the next day. Two patients showed globe tenting with a posterior globe angle of 110° or less, which was resolved on the following day. Two patients with initial visual acuity of counting fingers or better showed complete visual recovery. By contrast, only 1 of the 2 patients with no light perception slightly improved to light perception while the other showed no improvement after surgery. Conclusions: Bony orbital decompression is effective for the treatment of traumatic orbital compartment syndrome in patients whose preoperative visual acuity is counting fingers or better.