Imaging the Tight Orbit: Radiologic Manifestations of Orbital Compartment Syndrome

Area of Science:

• Ophthalmology
• Radiology
• Emergency Medicine

Background:

• Orbital compartment syndrome (OCS) is a critical condition causing increased intraorbital pressure and potential vision loss.
• Clinical diagnosis is primary, but imaging can be crucial when findings are equivocal.

Purpose of the Study:

• To systematically evaluate the computed tomography (CT) imaging features associated with orbital compartment syndrome.
• To correlate imaging findings with clinical presentation and patient outcomes.

Main Methods:

• A retrospective analysis of 29 patients diagnosed with OCS across two trauma centers.
• Pretreatment CT scans were analyzed for proptosis, optic nerve length, globe angle, extraocular muscle morphology, fractures, bleeding, and superior ophthalmic vein caliber.
• Clinical data and visual outcomes were extracted from patient records.

Main Results:

• Most OCS cases (29 patients) resulted from traumatic hematoma, with pathologies predominantly in the extraconal space.
• Significant findings included proptosis (mean 24.4mm vs 17.7mm), optic nerve stretching (mean 32.0mm vs 25.8mm), and decreased posterior globe angle (mean 128.7° vs 146.9°).
• A smaller superior ophthalmic vein was noted in 69% of affected orbits; extraocular muscles showed no significant changes.

Conclusions:

• Orbital compartment syndrome is characterized by proptosis and optic nerve stretching on CT imaging.
• Imaging can reveal globe deformation and identify pathologies anywhere within the orbit, supporting the compartment syndrome mechanism.
• CT findings aid in diagnosing OCS, especially when clinical presentation is ambiguous.