Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic Review

Serge Zogheib; Georges Sukkarieh; Georges Mjaess; Samer Abou Zeid

doi:10.1055/s-0041-1740290

Facial Plastic Surgery, Table of Contents

Facial Plast Surg 2022; 38(03): 274-278
DOI: 10.1055/s-0041-1740290

Original Research

Displaced Orbital Fractures with Concurrent Orbital Compartment Syndrome: A Case-Based Systematic Review

Serge Zogheib

¹Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

,

Georges Sukkarieh

²Department of Ophthalmology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

,

Georges Mjaess

¹Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

,

Samer Abou Zeid

¹Department of Plastic, Reconstructive and Cranio-Maxillo-Facial Surgery, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

› Author Affiliations

Abstract

Orbital compartment syndrome (OCS) is an emergency that complicates intra-orbital, retrobulbar hemorrhage in most cases. Bony orbital decompression is an effective treatment for OCS, and displaced orbital fractures are protective. Nevertheless, in rare cases, OCS occurs despite a displaced orbital fracture. The aim of the current review is to present its pathophysiology and management based on what is published in the medical literature, and our center's experience. A systematic review of literature was conducted through PubMed, Medline, Embase, and Cochrane from inception through February 2021. The following search query was used: “orbital fracture” and “trauma” and “orbital compartment syndrome.” Studies tackling the pathophysiology and management of concurrent displaced orbital fracture with OCS were included and a cohort of patients was constituted. A cohort of 18 cases reported in the literature were included (49.3 ± 30.6 years, 50% M). Given that OCS occurs with or without orbital fracture, pathophysiology of OCS is mostly explained by the division of the orbital fat into many compartments, due to the presence of Koorneef's fibrous septa. Management of OCS in such circumstances consisted of inferior-lateral canthotomy and cantholysis in 50% of cases, subperiosteal drainage with myringotomy in 22.2% of cases, subperiosteal drainage in 16.7% of cases, and complete lateral cantholysis in 16.7% of cases. Two cases who presented to our tertiary care center were also added to this review. Physicians should be aware that OCS can occur even with displaced fractures of the orbital cavity. When clinical suspicion is present, an emergent management is needed.

Keywords

orbital compartment syndrome - orbital fracture - canthotomy - cantholysis - trauma

Full Text

References

References
1 McCallum E, Keren S, Lapira M, Norris JH. Orbital compartment syndrome: an update with review of the literature. Clin Ophthalmol 2019; 13: 2189-2194
2 Kansakar P, Sundar G. Vision loss associated with orbital surgery—a major review. Orbit 2020; 39 (03) 197-208
3 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
4 Gart MS, Gosain AK. Evidence-based medicine: orbital floor fractures. Plast Reconstr Surg 2014; 134 (06) 1345-1355
5 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
6 Davis II DB, Mandel MR. Efficacy and complication rate of 16,224 consecutive peribulbar blocks. A prospective multicenter study. J Cataract Refract Surg 1994; 20 (03) 327-337
7 Chorich LJ, Derick RJ, Chambers RB. et al. Hemorrhagic ocular complications associated with the use of systemic thrombolytic agents. Ophthalmology 1998; 105 (03) 428-431
8 Patel SR, Mishall P, Barmettler A. A human cadaveric model for effective instruction of lateral canthotomy and cantholysis. Orbit 2020; 39 (02) 87-92
9 Larsen M, Wieslander S. Acute orbital compartment syndrome after lateral blow-out fracture effectively relieved by lateral cantholysis. Acta Ophthalmol Scand 1999; 77 (02) 232-233
10 Sun MT, Chan WO, Selva D. Traumatic orbital compartment syndrome: importance of the lateral canthotomy and cantholysis. Emerg Med Australas 2014; 26 (03) 274-278
11 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
12 Zachariades N, Papavassiliou D, Christopoulos P. Blindness after facial trauma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81 (01) 34-37
13 Gupta D, Beigi B. Orbital compartment syndrome despite significant traumatic expansion of the orbital cavity. Craniomaxillofac Trauma Reconstr 2017; 10 (03) 239-243
14 Kondoff M, Nassrallah G, Ross M, Deschênes J. Incidence and outcomes of retrobulbar hematoma diagnosed by computed tomography in cases of orbital fracture. Can J Ophthalmol 2019; 54 (05) 606-610
15 Schwitkis AE, Pollack TL, Torbati SS. Orbital compartment syndrome following mechanical fall. Clin Pract Cases Emerg Med 2018; 2 (03) 268-269
16 Gerbino G, Ramieri GA, Nasi A. Diagnosis and treatment of retrobulbar haematomas following blunt orbital trauma: a description of eight cases. Int J Oral Maxillofac Surg 2005; 34 (02) 127-131
17 Magarakis M, Mundinger GS, Kelamis JA, Dorafshar AH, Bojovic B, Rodriguez ED. Ocular injury, visual impairment, and blindness associated with facial fractures: a systematic literature review. Plast Reconstr Surg 2012; 129 (01) 227-233
18 Klenk G, Katona J, Kenderfi G, Lestyán J, Gombos K, Hirschberg A. Orbital compartment syndrome. The most frequent cause of blindness following facial trauma. Orv Hetil 2017; 158 (36) 1410-1420
19 Liu D. Complications of fine needle aspiration biopsy of the orbit. Ophthalmology 1985; 92 (12) 1768-1771
20 Burkat CN, Lemke BN. Retrobulbar hemorrhage: inferolateral anterior orbitotomy for emergent management. Arch Ophthalmol 2005; 123 (09) 1260-1262
21 Koornneef L. Spatial Aspects of Orbital Musculofibrous Tissue in Man: A New Anatomical and Histological Approach. Amsterdam: Swets en Zeitlinger; 1977
22 Dutton GN, al-Qurainy I, Stassen LFA, Titterington DM, Moos KF, el-Attar A. Ophthalmic consequences of mid-facial trauma. Eye (Lond) 1992; 6 (Pt 1): 86-89
23 Dalley RW, Robertson WD, Rootman J. Globe tenting: a sign of increased orbital tension. AJNR Am J Neuroradiol 1989; 10 (01) 181-186
24 Yung CW, 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
25 Oester Jr AE, Fowler BT, Fleming JC. Inferior orbital septum release compared with lateral canthotomy and cantholysis in the management of orbital compartment syndrome. Ophthal Plast Reconstr Surg 2012; 28 (01) 40-43
26 Strand AT, Czyz CN, Gibson A. Canthal cutdown for emergent treatment of orbital compartment syndrome. Orbit 2017; 36 (05) 285-292
27 Carrim ZI, Anderson IWR, Kyle PM. Traumatic orbital compartment syndrome: importance of prompt recognition and management. Eur J Emerg Med 2007; 14 (03) 174-176
28 McInnes G, Howes DW. Lateral canthotomy and cantholysis: a simple, vision-saving procedure. CJEM 2002; 4 (01) 49-52
29 Wolfort FG, Vaughan TE, Wolfort SF, Nevarre DR. Retrobulbar hematoma and blepharoplasty. Plast Reconstr Surg 1999; 104 (07) 2154-2162
30 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