TY - JOUR
T1 - Orbital Compartment Syndrome After High-speed Air-Gasoline Blast Injury
AU - Zhao, Zhenyang
AU - Malik, Amina
AU - Bhat, Nita
AU - Bindiganavile, Shruthi Harish
AU - Pandit, Rahul T.
AU - Kavoussi, Shaheen C.
AU - Lee, Andrew G.
N1 - Publisher Copyright:
© 2020 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Orbital compartment syndrome is an ophthalmologic emergency that requires timely surgical intervention. The authors present a rare case of orbital compartment syndrome in a 30-year-old male injured by forceful entry of air-gasoline mixture into the orbit, secondary to inadvertent firing of the piston from running mechanical diagnostics on an automobile internal combustion engine. Orbital CT revealed extensive orbital emphysema with both pre- and postseptal involvement and diffuse chemical cellulitis. Serial exams revealed rapid deterioration of vision with elevated intraocular pressure and development of eyelid, corneal, and orbital edema; a relative afferent pupillary defect and optic nerve hypoperfusion. He was started on intravenous steroids and underwent an emergent lateral canthotomy with cantholysis, which temporarily reduced the intraocular pressure. However, a second rapid increase in soft tissue swelling resulted in another episode of ocular hypertension and compressive optic neuropathy, requiring emergent orbital bony decompression, which was followed by decreased intraocular and orbital pressure. The patient later developed progressive corneal opacification indicating delayed chemical injury. This was managed with a 10-day course of aggressive topical and systemic antiinflammatory agents with significant improvement in visual acuity. At last follow up, the vision was 20/30 and the corneal and eyelid edema had cleared.
AB - Orbital compartment syndrome is an ophthalmologic emergency that requires timely surgical intervention. The authors present a rare case of orbital compartment syndrome in a 30-year-old male injured by forceful entry of air-gasoline mixture into the orbit, secondary to inadvertent firing of the piston from running mechanical diagnostics on an automobile internal combustion engine. Orbital CT revealed extensive orbital emphysema with both pre- and postseptal involvement and diffuse chemical cellulitis. Serial exams revealed rapid deterioration of vision with elevated intraocular pressure and development of eyelid, corneal, and orbital edema; a relative afferent pupillary defect and optic nerve hypoperfusion. He was started on intravenous steroids and underwent an emergent lateral canthotomy with cantholysis, which temporarily reduced the intraocular pressure. However, a second rapid increase in soft tissue swelling resulted in another episode of ocular hypertension and compressive optic neuropathy, requiring emergent orbital bony decompression, which was followed by decreased intraocular and orbital pressure. The patient later developed progressive corneal opacification indicating delayed chemical injury. This was managed with a 10-day course of aggressive topical and systemic antiinflammatory agents with significant improvement in visual acuity. At last follow up, the vision was 20/30 and the corneal and eyelid edema had cleared.
KW - Adult
KW - Blast Injuries/etiology
KW - Compartment Syndromes/diagnosis
KW - Decompression, Surgical
KW - Gasoline
KW - Humans
KW - Male
KW - Orbit/surgery
KW - Orbital Diseases/surgery
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UR - http://www.scopus.com/inward/citedby.url?scp=85106195162&partnerID=8YFLogxK
U2 - 10.1097/IOP.0000000000001845
DO - 10.1097/IOP.0000000000001845
M3 - Article
C2 - 33079761
AN - SCOPUS:85106195162
SN - 0740-9303
VL - 37
SP - E97-E100
JO - Ophthalmic Plastic and Reconstructive Surgery
JF - Ophthalmic Plastic and Reconstructive Surgery
IS - 3
ER -