Orbital compartment syndromes following trauma

Area of Science:

• Ophthalmology
• Neurology
• Trauma Surgery

Background:

• The exact causes of traumatic optic neuropathy are often unclear, particularly when elevated intraocular pressure and central retinal artery occlusion (CRAO) are not observed.
• Potential mechanisms vary, and the etiology likely differs among individual cases.
• Prognosis appears better if vision is initially preserved and then declines, suggesting reversible compression.

Purpose of the Study:

• To explore the potential benefits and considerations of orbital decompression surgery for traumatic optic neuropathy.
• To evaluate the decision-making process for surgical intervention in cases of severe orbital hemorrhage and pressure.

Main Methods:

• Review of existing literature on traumatic optic neuropathy and orbital decompression.
• Analysis of clinical signs, including proptosis, associated with optic neuropathy.
• Consideration of outcomes from treating compressive optic neuropathy in Grave's disease.

Main Results:

• Systemic steroids are sometimes recommended as initial therapy.
• Orbital hemorrhage, edema, or emphysema can lead to significant pressure in the orbit.
• Anecdotal reports suggest vision restoration following decompression in trauma, though efficacy is uncertain.

Conclusions:

• Orbital decompression is technically feasible and has shown success in other compressive optic neuropathies.
• While the efficacy in trauma is not definitively established, it may be appropriate for rare cases with significant orbital pressure signs.
• Informed consent is crucial due to the uncertain outcomes of decompression in traumatic optic neuropathy.