Orbital compartment syndrome: Difference between revisions
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''Do NOT delay treatment for diagnostic studies if there is already a high clinical suspicion for OCS'' | ''Do NOT delay treatment for diagnostic studies if there is already a high clinical suspicion for OCS'' | ||
*'''Tonometry''' ([[Tono-pen]]) | |||
**Do NOT use until [[globe rupture]] has been excluded | |||
**Normal pressure 10-20mmHg; pressure >35mmHg suggests OCS<ref>Stiff, H., 2018. Orbital Compartment Syndrome Curriculum. [online] Eyerounds.org. Available at: <https://eyerounds.org/tutorials/ocs/index.htm> [Accessed 29 June 2021].</ref> | |||
* '''Labs''' | * '''Labs''' | ||
**CBC/BMP (if history of trauma or cellulitis) | **CBC/BMP (if history of trauma or cellulitis) | ||
**Coag panel (coagulopathy suggests retrobulbar hemorrhage) | **Coag panel (coagulopathy suggests [[retrobulbar hemorrhage]]) | ||
*'''Imaging''' | *'''Imaging''' | ||
**CT | **CT (Orbit) | ||
***May help identify etiology or exclude diagnoses | ***May help identify etiology or exclude diagnoses | ||
***75% of OCS cases will show a change in posterior globe configuration ("globe tenting") | ***75% of OCS cases will show a change in posterior globe configuration ("globe tenting") | ||
**Ultrasound | **[[Ocular ultrasound|Ultrasound (orbit)]] | ||
***Not been validated for AOCS, but may identify other ocular pathologies (retinal detachment, central retinal artery occlusion, lens dislocation, vitreous hemorrhage, and vitreous detachment<ref>Blavias, M., 2002. A study of bedside ocular ultrasonography in the emergency department.. [online] Reference.medscape.com. Available at: <https://reference.medscape.com/medline/abstract/12153883> [Accessed 29 June 2021].</ref> | ***Not been validated for AOCS, but may identify other ocular pathologies (retinal detachment, central retinal artery occlusion, lens dislocation, vitreous hemorrhage, and vitreous detachment<ref>Blavias, M., 2002. A study of bedside ocular ultrasonography in the emergency department.. [online] Reference.medscape.com. Available at: <https://reference.medscape.com/medline/abstract/12153883> [Accessed 29 June 2021].</ref> | ||
Revision as of 18:46, 29 June 2021
Background[1]
- Rare, vision-threatening ophthalmic emergency characterized by an acute elevation of intra-orbital pressure which exceeds the vascular perfusion pressure of the ophthalmic artery.
- Most commonly caused by acute orbital or facial trauma
- Less common causes include local injections, orbital infection, orbital emphysema, foreign bodies, and spontaneous hemorrhage
Clinical Features
- Decreased visual acuity
- Afferent pupillary defect
- Difficulty opening eyelids
- Limited motility
- Proptosis
Differential Diagnosis[2]
- Retinal detachment
- Globe rupture
- Endophthalmitis
- Optic nerve decompression
- Anterior ischemic optic neuropathy (AION)
Evaluation
Workup
Do NOT delay treatment for diagnostic studies if there is already a high clinical suspicion for OCS
- Tonometry (Tono-pen)
- Do NOT use until globe rupture has been excluded
- Normal pressure 10-20mmHg; pressure >35mmHg suggests OCS[3]
- Labs
- CBC/BMP (if history of trauma or cellulitis)
- Coag panel (coagulopathy suggests retrobulbar hemorrhage)
- Imaging
- CT (Orbit)
- May help identify etiology or exclude diagnoses
- 75% of OCS cases will show a change in posterior globe configuration ("globe tenting")
- Ultrasound (orbit)
- Not been validated for AOCS, but may identify other ocular pathologies (retinal detachment, central retinal artery occlusion, lens dislocation, vitreous hemorrhage, and vitreous detachment[4]
- CT (Orbit)
Diagnosis
- Diagnosis made clinically with afferent pupillary defect, vision loss, and intraocular pressure >40mmHg
Management
Disposition
See Also
External Links
References
- ↑ Murchison, A., 2021. Orbital Compartment Syndrome - EyeWiki. [online] Eyewiki.org. Available at: <https://eyewiki.org/Orbital_Compartment_Syndrome> [Accessed 29 June 2021].
- ↑ Shannon, B., 2019. Acute Orbital Compartment Syndrome Differential Diagnoses. [online] Emedicine.medscape.com. Available at: <https://emedicine.medscape.com/article/799528-differential> [Accessed 29 June 2021].
- ↑ Stiff, H., 2018. Orbital Compartment Syndrome Curriculum. [online] Eyerounds.org. Available at: <https://eyerounds.org/tutorials/ocs/index.htm> [Accessed 29 June 2021].
- ↑ Blavias, M., 2002. A study of bedside ocular ultrasonography in the emergency department.. [online] Reference.medscape.com. Available at: <https://reference.medscape.com/medline/abstract/12153883> [Accessed 29 June 2021].