Update on orbital decompression as emergency treatment of traumatic blindness

Abstract Introduction Blindness is a rare and severe complication of craniofacial trauma. The management of acute orbital compartment syndrome (AOCS) is not well defined and there is no standard treatment. Our objective was to find indications for orbital decompression, the best time for treatment,...

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Bibliographic Details
Published in:Journal of cranio-maxillo-facial surgery 2015-09, Vol.43 (7), p.1000-1003
Main Authors: Soare, Silvia, Foletti, Jean-Marc, Gallucci, Audrey, Collet, Charles, Guyot, Laurent, Chossegros, Cyrille
Format: Article
Language:English
Subjects:
Blindness - etiology
Blindness - surgery
Compartment Syndromes - etiology
Craniocerebral Trauma - complications
Decompression, Surgical - methods
Dentistry
Human health and pathology
Humans
Life Sciences
Orbit - surgery
Orbital compression syndrome
Orbital decompression
Surgery
Trauma
Visual Acuity - physiology
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Summary:Abstract Introduction Blindness is a rare and severe complication of craniofacial trauma. The management of acute orbital compartment syndrome (AOCS) is not well defined and there is no standard treatment. Our objective was to find indications for orbital decompression, the best time for treatment, and the appropriate techniques. Materials and methods A literature review was made from articles published between 1994 and 2014 in the PubMed database, on the emergency treatment of AOCS. Results 59 of the 89 patients treated surgically for AOCS presented with significant improvement of visual acuity (VA) after orbital decompression. The delay between trauma and surgery was short. A lateral canthotomy with inferior cantholysis (LCIC) was the most frequently used technique. Discussion AOCS with a risk of visual impairment must be decompressed in emergency, at best in the 2 hours following trauma, most often by LCIC to have the best chance of recovering VA. Adjuvant medical treatment (acetazolamide, mannitol, corticosteroids) should not delay surgery. Postoperative corticosteroid therapy is not indicated, especially in patients with severe head trauma.
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2015.05.003