• Michelle T Sun, Weng Onn Chan, and Dinesh Selva.
• Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology and Royal Adelaide Hospital, Adelaide, South Australia, Australia.
• Emerg Med Australas. 2014 Jun 1;26(3):274-8.

BackgroundOrbital compartment syndrome (OCS) is an ophthalmic emergency that requires urgent surgical decompression to preserve vision.ObjectiveTo describe the clinical presentation, management and outcomes for patients with traumatic OCS.MethodsRetrospective case series of eight patients with OCS secondary to blunt trauma presenting to the Royal Adelaide Hospital between 2004 and 2013.ResultsAll patients had acute, painful decrease in visual acuity and proptosis. Common examination findings included a relative afferent pupillary defect, periorbital oedema, ophthalmoparesis and chemosis. All patients underwent surgical decompression in the form of a lateral canthotomy or cantholysis. Three patients who were decompressed within 2 h after injury recovered fully. One patient who sustained a macular hole at the time of injury recovered four lines of Snellen acuity after being decompressed within 1 h. Another patient recovered three lines of Snellen acuity after undergoing decompression at 2.5 h post-injury. The remaining patients had minimal visual recovery, with postoperative visual acuities ranging from hand movements to no perception to light. Of these patients, one was decompressed at 2 h, while the remaining underwent decompression at 4 and 6 h post-injury.ConclusionsPrompt decompression is essential for visual recovery in OCS, which appears maximal if performed within 2 h of injury. All patients presenting with history and examination findings suggestive of OCS should undergo emergency canthotomy and cantholysis prior to any additional investigations to minimise visual loss.© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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