Pterional orbital decompression in diseases with acute increase of intraorbital pressure

Orbital cellulitis as well as traumatic or spontaneous intraorbital hemorrhages can lead to an acute rise of intraorbital pressure, threatening the function of orbital vascular, muscular and neural structures. The treatment of this rare entity with extended pterional orbital decompression is described in comparison with other methods of orbital decompression.

Between 1991 and 2000 the authors treated 16 patients with sight-threatening acute elevations of intraorbital pressure due to orbital cellulitis (3 patients) and spontaneous (3 patients), postoperative (1 patient) or traumatic diffuse or localized intraorbital hemorrhage (9 patients) with extended pterional orbital decompression. Pre- and postoperative parameters, like visual acuity, exophthalmos, restrictions of extraocular motility and pupillary disturbances, were retrospectively analyzed.

In all patients, a distinct improvement of preoperative symptoms, like complete reduction of proptosis in all cases, improvement of visual acuity in 12 patients, improvement of eye motility disturbances in 14 patients and of afferent pupillary disturbances in 6 patients, was achieved by decompressing the orbital contents within a mean of 30.5 hours after onset of symptoms. Severe, operation-related complications were not seen.

Extended pterional orbital decompression represents an effective treatment alternative and supplement in cases of severe, ocular function-threatening cases of acute elevated orbital pressure, due, for example, to orbital cellulitis or diffuse or localized spontaneous and traumatic intraorbital hemorrhage, where immediate reduction of pressure on orbital neural, muscular and vascular structures is intended.