Orbital Compartment Syndrome After High-speed Air-Gasoline Blast Injury

Area of Science:

• Ophthalmology
• Trauma Surgery

Background:

• Orbital compartment syndrome (OCS) is an ophthalmologic emergency demanding immediate surgical intervention.
• Prompt diagnosis and management are crucial to prevent irreversible vision loss.

Observation:

• A 30-year-old male sustained an orbital compartment syndrome from forceful air-gasoline mixture entry into the orbit.
• Orbital CT showed extensive orbital emphysema, pre- and postseptal involvement, and chemical cellulitis.
• The patient experienced rapid vision deterioration, elevated intraocular pressure, and signs of optic nerve compromise.

Findings:

• Emergent lateral canthotomy with cantholysis provided temporary relief of intraocular pressure.
• Subsequent orbital bony decompression was necessary to address recurrent ocular hypertension and compressive optic neuropathy.
• Delayed corneal opacification due to chemical injury was managed with intensive anti-inflammatory therapy.

Implications:

• This case underscores the critical importance of timely surgical decompression in managing orbital compartment syndrome, even in rare etiologies.
• Aggressive anti-inflammatory treatment is vital for managing delayed complications like chemical-induced corneal opacification.
• Successful visual recovery (20/30) was achieved through a multi-step surgical and medical approach.