Recommended Citation
Sayed F, Grahf D. Possible Role of Pharmaceutical Interventions in Orbital Compartment Syndrome. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
Orbital compartment syndrome is an ophthalmologic emergency characterized by intraorbital pressures exceeding ophthalmic arterial pressure with resultant ischemia to the retina and optic nerve and often irreversible vision loss. It is a clinical diagnosis in the setting of optic neuropathy and increased intraocular pressures and imaging is not required. Timely intervention is a hallmark of treatment with improved outcomes associated with decompression within two hours. The standard of care is lateral canthotomy with cantholysis to restore perfusion and preserve eyesight. While medical and pharmaceutical interventions and treatment play a supplemental role in treatment, their effectiveness has not been confirmed.
Description:
The patient is a 44-year-old male with a history of hypertension and an unspecified “brain palsy” reported by the family who presented after a mechanical fall. He tripped resulting in trauma to the right side of his face. On exam he had decreased visual acuity to the right eye, worse than 20/200, increased intraocular pressure (IOP) with right eye pressure of 45mmHg and left eye pressure of 15mmHg, as well as limited extraocular movements with inability to look up, down, or move his right eye in a lateral direction. CT imaging showed right orbital retrobulbar hemorrhage with proptosis. His right pupil was non-reactive to light. His presentation, exam, and imaging were concerning for orbital compartment syndrome. After extensive discussion, the patient and family decided against lateral canthotomy and left against medical advice. As possible salvage therapy, ophthalmology recommended high dose 100mg IV hydrocortisone and timolol, dorzolamide, and brimonidine drops BID. He returned three days later with a significantly improved exam where he was found to have acuity of 20/30 for both eyes, R IOP of 24, and near full range of extraocular movements.
Discussion:
Orbital compartment syndrome is a clinical diagnosis in which timely recognition and intervention is paramount. First line treatment is lateral canthotomy and cantholysis for decompression and reperfusion of the retina and optic nerve. The role of pharmaceutical interventions remains peripheral. It would be difficult to ethically develop a trial comparing pharmaceutical intervention to surgical decompression. However, in decisional patients adamant on not undergoing lateral canthotomy and cantholysis, this case shows there may be options for possible salvage therapy.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
wf_yes
Document Type
Poster
Open Access
Available to all.
Possible Role of Pharmaceutical Interventions in Orbital Compartment Syndrome
Introduction/Background:
Orbital compartment syndrome is an ophthalmologic emergency characterized by intraorbital pressures exceeding ophthalmic arterial pressure with resultant ischemia to the retina and optic nerve and often irreversible vision loss. It is a clinical diagnosis in the setting of optic neuropathy and increased intraocular pressures and imaging is not required. Timely intervention is a hallmark of treatment with improved outcomes associated with decompression within two hours. The standard of care is lateral canthotomy with cantholysis to restore perfusion and preserve eyesight. While medical and pharmaceutical interventions and treatment play a supplemental role in treatment, their effectiveness has not been confirmed.
Description:
The patient is a 44-year-old male with a history of hypertension and an unspecified “brain palsy” reported by the family who presented after a mechanical fall. He tripped resulting in trauma to the right side of his face. On exam he had decreased visual acuity to the right eye, worse than 20/200, increased intraocular pressure (IOP) with right eye pressure of 45mmHg and left eye pressure of 15mmHg, as well as limited extraocular movements with inability to look up, down, or move his right eye in a lateral direction. CT imaging showed right orbital retrobulbar hemorrhage with proptosis. His right pupil was non-reactive to light. His presentation, exam, and imaging were concerning for orbital compartment syndrome. After extensive discussion, the patient and family decided against lateral canthotomy and left against medical advice. As possible salvage therapy, ophthalmology recommended high dose 100mg IV hydrocortisone and timolol, dorzolamide, and brimonidine drops BID. He returned three days later with a significantly improved exam where he was found to have acuity of 20/30 for both eyes, R IOP of 24, and near full range of extraocular movements.
Discussion:
Orbital compartment syndrome is a clinical diagnosis in which timely recognition and intervention is paramount. First line treatment is lateral canthotomy and cantholysis for decompression and reperfusion of the retina and optic nerve. The role of pharmaceutical interventions remains peripheral. It would be difficult to ethically develop a trial comparing pharmaceutical intervention to surgical decompression. However, in decisional patients adamant on not undergoing lateral canthotomy and cantholysis, this case shows there may be options for possible salvage therapy.
Affiliations
Advocate Christ Medical Center