Orbital compartment syndrome in burn patients

To identify clinical characteristics of burn patients requiring emergent orbital decompression for vision-threatening orbital compartment syndrome.

A retrospective review of 28 burn patients at a trauma center provided data regarding demographics, physical examination findings, and resuscitation fluid volumes. Patients requiring orbital decompression were compared with those who did not, using t tests and Fisher exact test. Linear regression was used to test for an association between peak intraocular pressure and fluid volume. Logistic regression was used to assess associations between need for orbital decompression and fluid volume.

Eight of 28 patients required emergent orbital decompression, which immediately reduced intraocular pressure from 59.4 +/- 15.9 mm Hg to 28.6 +/- 8.2 mm Hg (p < 0.001). There was a positive relationship between fluid volume in the first 24 hours and peak intraocular pressure (p < 0.001). Patients who were treated with orbital decompression were resuscitated with a higher fluid volume in the first 24 hours than those who were not (37,218 +/- 14,405 ml versus 24,649 +/- 12,339 ml, p = 0.015). This was no longer statistically significant when adjusted for periocular burns. The relative risk for undergoing orbital decompression in patients receiving > or =8.6 ml/kg/% total body surface area burned in the first 24 hours was 4.4 (p = 0.03).

Risk factors for vision-threatening orbital compartment syndrome include fluid volume and periocular burns. Signs of vision-threatening orbital compartment syndrome should be addressed early with orbital decompression.