Elevated Intraocular Pressure in Burn Patients Undergoing Fluid Resuscitation: An Opportunity to Avoid Orbital Compartment Syndrome

Abstract

Objective This study aims to discuss clinical characteristics of burn patients who developed elevated intraocular pressure (IOP). We propose management strategies to prevent orbital compartment syndrome before invasive treatment is required.

Methods A retrospective review of 47 burn patients at the University of California San Diego (UCSD), Burn Intensive Care Unit (ICU; major regional burn center for San Diego county), was analyzed for demographics, fluid resuscitation volumes, and physical exam findings. Patients requiring topical treatment for high-IOP, defined as ≥30 mm Hg in either or both eyes, were compared with those who did not require treatment, using the t-test and Fisher's exact test. Linear regression tested for an association between peak IOP and fluid volume. Logistic regression evaluated the association between total fluid and treatment of high IOP, while adjusting for other characteristics.

Results Six of 47 patients required IOP-lowering treatment. Of the patients requiring treatment, one drop of dorzolamide/timolol in both eyes twice daily was the most common treatment recommendation. Presence of periocular burns was a significant risk factor in patients who required treatment for high IOP. No patients developed orbital compartment syndrome or required surgical intervention to lower IOP. The mean total fluid volume delivered in the first 24 hours was 0.8 times the level prescribed by fluid resuscitation guidelines.

Conclusion By treating early clinical signs and properly managing fluid resuscitation, development of orbital compartment syndrome in burn patients can be avoided.

Keywords

elevated intraocular pressure - orbital compartment syndrome - orbital decompression - fluid resuscitation - parkland formula - burn

• References

• 1 Lima V, Burt B, Leibovitch I, Prabhakaran V, Goldberg RA, Selva D. Orbital compartment syndrome: the ophthalmic surgical emergency. Surv Ophthalmol 2009; 54 (04) 441-449
• 2 Klein MB, Hayden D, Elson C. , et al. The association between fluid administration and outcome following major burn: a multicenter study. Ann Surg 2007; 245 (04) 622-628
• 3 Oda J, Yamashita K, Inoue T. , et al. Resuscitation fluid volume and abdominal compartment syndrome in patients with major burns. Burns 2006; 32 (02) 151-154
• 4 Ivy ME, Atweh NA, Palmer J, Possenti PP, Pineau M, D'Aiuto M. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 2000; 49 (03) 387-391
• 5 Perron AD, Brady WJ, Keats TE. Orthopedic pitfalls in the ED: acute compartment syndrome. Am J Emerg Med 2001; 19 (05) 413-416
• 6 Goodall KL, Brahma A, Bates A, Leatherbarrow B. Lateral canthotomy and inferior cantholysis: an effective method of urgent orbital decompression for sight threatening acute retrobulbar haemorrhage. Injury 1999; 30 (07) 485-490
• 7 Baxter CR, Shires T. Physiological response to crystalloid resuscitation of severe burns. Ann N Y Acad Sci 1968; 150 (03) 874-894
• 8 Engrav LH, Colescott PL, Kemalyan N. , et al. A biopsy of the use of the Baxter formula to resuscitate burns or do we do it like Charlie did it?. J Burn Care Rehabil 2000; 21 (02) 91-95
• 9 Friedrich JB, Sullivan SR, Engrav LH. , et al. Is supra-Baxter resuscitation in burn patients a new phenomenon?. Burns 2004; 30 (05) 464-466
• 10 Cancio LC, Chávez S, Alvarado-Ortega M. , et al. Predicting increased fluid requirements during the resuscitation of thermally injured patients. J Trauma 2004; 56 (02) 404-413 , discussion 413–414
• 11 Singh CN, Klein MB, Sullivan SR. , et al. Orbital compartment syndrome in burn patients. Ophthal Plast Reconstr Surg 2008; 24 (02) 102-106
• 12 Sullivan SR, Ahmadi AJ, Singh CN. , et al. Elevated orbital pressure: another untoward effect of massive resuscitation after burn injury. J Trauma 2006; 60 (01) 72-76
• 13 Saffle JI. The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res 2007; 28 (03) 382-395
• 14 Saffle JR. Fluid Creep and Over-resuscitation. Crit Care Clin 2016; 32 (04) 587-598
• 15 Tekin A, Namias N, O'Keeffe T. , et al. A burn mass casualty event due to boiler room explosion on a cruise ship: preparedness and outcomes. Am Surg 2005; 71 (03) 210-215
• 16 Winterton JV, Patel K, Mizen KD. Review of management options for a retrobulbar hemorrhage. J Oral Maxillofac Surg 2007; 65 (02) 296-299
• 17 Vassallo S, Hartstein M, Howard D, Stetz J. Traumatic retrobulbar hemorrhage: emergent decompression by lateral canthotomy and cantholysis. J Emerg Med 2002; 22 (03) 251-256
• 18 Ballard SR, Enzenauer RW, O'Donnell T, Fleming JC, Risk G, Waite AN. Emergency lateral canthotomy and cantholysis: a simple procedure to preserve vision from sight threatening orbital hemorrhage. J Spec Oper Med 2009; 9 (03) 26-32
• 19 Rowh AD, Ufberg JW, Chan TC, Vilke GM, Harrigan RA. Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome. J Emerg Med 2015; 48 (03) 325-330
• 20 Kitaguchi Y, Takahashi Y, Sabundayo MS, Kakizaki H. Bony orbital decompression following lateral canthotomy and cantholysis for traumatic orbital compartment syndrome. J Craniofac Surg 2019; 30 (01) 231-234
• 21 Rosdeutscher JD, Stadelmann WK. Diagnosis and treatment of retrobulbar hematoma resulting from blunt periorbital trauma. Ann Plast Surg 1998; 41 (06) 618-622
• 22 Yung C-W, Moorthy RS, Lindley D, Ringle M, Nunery WR. Efficacy of lateral canthotomy and cantholysis in orbital hemorrhage. Ophthal Plast Reconstr Surg 1994; 10 (02) 137-141
• 23 Krausen AS, Ogura JH, Burde RM, Ostrow DE. Emergency orbital decompression: a reprieve from blindness. Otolaryngol Head Neck Surg 1981; 89 (02) 252-256
• 24 Prodhan P, Noviski NN, Butler WE, Eskandar E, Ellen Grant P, Whalen MJ. Orbital compartment syndrome mimicking cerebral herniation in a 12-yr-old boy with severe traumatic asphyxia. Pediatr Crit Care Med 2003; 4 (03) 367-369