Posted by - Posted on 06/28/2015 19:27:09 oculoplastics
44 year old presented to the ER with severe proptosis and loss of vision following a bout of coughing. Vision was LP and IOP 60 mm Hg as measured by tonopen. History was significant for blood thinners that was strated 2 years prior following bypass and cardic stent. Whta is the diagnosis and outline the managment?
Retro orbital Hematoma
* Orbital hematoma is an emergency and can lead to blindness from Optic nerve or retinal circulation compression.
* Proptosis, Elevated IOP and loss of vision (RAPD) are indications for emergency decompression
* Lateral orbital canthotomy is the procedure of choice
Retrobulbar hematoma is the most common cause of orbital compartment syndrome and is usually secondary to trauma or a surgical procedure. Other potential etiologies of an increase in orbital compartment pressures include infection, intraocular emphysema, tumor, and inflammation.
Acute orbital compartment syndrome with visual acuity loss is an emergency. Permanent blindness occurs if effective therapy is not initiated in a timely manner. Emergent decompressive surgery (ie, lateral canthotomy and inferior cantholysis) may save sight in patients with severe symptoms. Remember, irreversible visual loss can occur with retinal ischemia that lasts longer than 120 minutes.
Symptoms and signs of acute orbital compartment syndrome may include the following:
What happened to our patient: Underwent emeregent lateral cantholysis in the ER by the Glaucoma fellow resulting decompression and decrease in IOP. VA improved from LP to 20/50 with in a few hours. At one week, the vision was 20/40, IOP was 15 but still had significant OM restrictions along with propotosis. He is expected to make recovery with in the next few weeks.