A Split from Traditional Orbital Compartment Syndrome Intervention: Case Report of Vision-saving Vertical Lid Split...

Many emergency physicians will never perform a lateral canthotomy and cantholysis, and one-third of those who try will be unsuccessful at relieving the pressure that threatens permanent vision loss. This procedure is notoriously difficult and rare, but a recently proposed alternative-the vertical lid split-may be simpler and more effective.

We report the case of a 35-year-old woman with motor vehicle collision-related orbital trauma who presented to a community emergency department. Initially, she had intact vision and extraocular movements. Imaging showed a comminuted inferior orbital blowout fracture with retrobulbar hemorrhage, and the transfer process was initiated. However, after coughing she developed vision loss and elevated intraocular pressure. Lateral canthotomy and cantholysis was performed for suspected orbital compartment syndrome but did not fully address the elevated pressures or restore vision. The emergency physician then performed a vertical lid split procedure, which fully restored vision and normalized pressures.

To the best of our knowledge, this is the first case report of orbital compartment syndrome to be treated with vertical lid split, and the first case report of any full-thickness eyelid incision technique being used for salvage of an unsuccessful lateral canthotomy and cantholysis; the result was excellent.