Orbital Compartment Syndrome and Irreversible Blindness Related to Orbital Varix Thrombosis: A Case Report

Orbital compartment syndrome (OCS) is an ocular emergency that can severely threaten the visual potential. The most common etiologies include facial trauma-related orbital wall fractures and postoperative bleeding within the orbit. Nontraumatic cases were also reported sporadically, although they are rare. The orbital volume limits the compliance to expand when space-occupying lesions develop. Both direct compression of the optic nerve and depleted perfusion from elevated intraorbital pressure subsequently lead to ischemic optic neuropathy and vision loss.

A 74-year-old man experienced headache, bulging left eye, dull pain, vision loss, nausea, and vomiting within 1 day. Computed tomography and magnetic resonance imaging revealed a heterogeneous mass extending from the orbital apex and connected with the ophthalmic vein. Lateral canthotomy and cantholysis were performed at bedside for emergent orbital decompression. The proptosis and pain relieved after surgery, but visual loss remained irreversible. Surgical exploration was conducted and pathology proved the diagnosis of varix of the ophthalmic vein with thrombosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians should be aware of the presentation of OCS and perform timely orbital decompression, which could reverse visual impairment. These patients might also benefit from immediate consultants with ophthalmologists and radiologists.