Managing orbital compartment syndrome
Reviewed by Jaya Myneni

This experimental study using cadaveric models was done to evaluate the surgical technique effective in relieving orbital compartment syndrome. Twelve cadaveric orbits were injected with blood analogue stained with fluorescein. Pressure probes were inserted in superotemporal (advanced 40mm into orbit) and medial locations (advanced 30mm at caruncle) to monitor orbital pressures (OP) at baseline and after stepwise injections of 5ml for a total of 20ml. OP was measured sequentially after lateral canthotomy, inferior cantholysis, superior cantholysis and canthal cutdown. A cutdown is described as division of orbital septum inferolaterally with further blunt dissection to disrupt compartment septae. Additional 10ml of solution was then reinjected to simulate dynamic haemorrhage and OP was checked. Two orbits were used as controls to study OP changes with time. In this study, canthotomy alone produced insignificant mean reduction of OP. With addition of inferior cantholysis, the reduction was significant. Significant reductions in medial compartment were observed only after superior cantholysis. With cutdown, an additional 74% of reduction in OP was noticed. The authors infer that in situations where there is no clinical response to canthotomy and cantholysis alone or where there is active bleeding cutdown might be helpful. The study is limited due to differences in elasticity between cadaveric model to human eyes.

Canthal cut down for emergent treatment of orbital compartment syndrome.
Strand AT, Czyz CN, Gibson A.
ORBIT
2017;36(5):285-92.