Prompt intervention key to managing compartment syndrome and white-eyed blowout

October 25, 2004

New Orleans-Certain orbital injuries require prompt intervention to avoid permanent ocular immobility and vision loss, according to David Weinberg, MD, from South Burlington, VT.

Dr. Weinberg pointed out that compartment syndrome, which causes local tissue pressure and compromises tissue perfusion, is one such situation and he advised that lateral canthotomy and cantholysis comprise the initial approach to these patients. This combination approach, which is successful in most cases, relaxes the injured eye, allows the eye to come forward, and relieves the compartment syndrome.

"Don't wait to administer steroids or for the results of imaging," he emphasized at the annual meeting of the American Academy of Ophthalmology.

Another situation that needs prompt attention is the patient who presents with a white-eyed blowout fracture, which is characterized by an absence of edema but great ocular restriction. This injury has the potential for marked oculocardiac reflex and prolapse of the eye into the maxillary sinus among others. He pointed out that in this type of injury that might have negative imaging studies.

"There is a great deal of evidence that if these patients do not receive prompt attention they will have permanent ocular restriction," he said. Dr. Weinberg advised educating emergency room physicians to the importance of rapid assessment.