Orbital compartment syndrome after periocular acupuncture: Vision preserved by emergent decompression

Acupuncture is widely utilized as a safe complementary therapy, but its application in the periocular region carries underappreciated vascular risks. We report a rare case of orbital compartment syndrome immediately following periocular acupuncture. Upon presentation to the Emergency Department 90 min post-procedure, the patient exhibited periorbital ecchymosis, tense eyelid edema, proptosis, complete ophthalmoplegia, an intraocular pressure of 79 mmHg, visual acuity of no light perception, and an absent pupillary light reflex. Emergent surgical decompression via lateral canthotomy and inferior cantholysis was executed within 2 h of symptom onset. Post-decompression, the intraocular pressure normalized, and the visual acuity progressively recovered to 20/25 by 3 months. Despite this excellent functional recovery, advanced imaging at 6 months via optical coherence tomography (OCT) and OCT angiography revealed permanent subclinical sequelae, including diffuse thinning of the macular ganglion cell-inner plexiform layer and capillary dropout within the deep capillary plexus. This case represents the first documented report of orbital compartment syndrome secondary to periocular acupuncture, in which emergent intervention remarkably restored visual acuity from no light perception to 20/25. It underscores that emergency physicians must perform immediate surgical decompression based on clinical grounds; significant visual salvage remains achievable in eyes presenting with no light perception if managed urgently. Furthermore, favorable recovery of visual acuity does not preclude long-term structural and microvascular damage, emphasizing the necessity of longitudinal ophthalmic follow-up.