Update on orbital decompression as emergency treatment of traumatic blindness

• 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
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2015.05.003

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.