• Yun-Hsiu Hsieh, Tzu-Heng Weng, Ming-Cheng Tai, and Ke-Hung Chien.
• Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan (R.O.C.).
• Medicine (Baltimore). 2017 Dec 1; 96 (49): e9096.

RationaleOrbital compartment syndrome (OCS) is a rare occurrence after transvenous embolization of indirect carotid-cavernous fistula (CCF). A lateral canthotomy and cantholysis are the most commonly performed surgical interventions. In our case, as the acute OCS occurred immediately after an uneventful transvenous embolization, an orbital floor orbitectomy was performed.Patient ConcernsHere, we present a rare case of a 59-year-old patient who required a transvenous embolization of an indirect CCF and subsequently immediately developed an acute OCS.DiagnosesAn indirect CCF was revealed using brain magnetic resonance angiography and a transvenous embolization of the fistula was performed using coils. Post-embolization angiograms revealed an occlusion of the CCF.InterventionsAfter the development of a relative afferent pupillary defect and acute OCS, we performed a lateral canthotomy, superior and inferior cantholysis, and an orbital floor orbitectomy. Subsequently, visual acuity and intraocular pressure improved.LessonsOur case is the first report of acute OCS occurring after transvenous embolization of a CCF that required further orbital floor decompression to prevent permanent visual loss. Moreover, our case demonstrates that acute OCS may rapidly develop after transvenous embolization due to superior ophthalmic venous (SOV) thrombosis and that an early intervention may reduce the risk of visual impairment.

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