Emergency Department Lateral Canthotomy for Traumatic Orbital Compartment Syndrome: A Case Report"

Abstract Background Trauma to face and eyes can result in retrobulbar hemorrhage. Significant hemorrhage in a closed orbital space can result in orbital compartment syndrome (OCS) which is dealt as an ophthalmic emergency. OCS can cause irreversible vision loss, if not treated timely. Lateral canthotomy is readily performed on the bedside and can prevent irreversible vision loss, caused by acute OCS. Although consultation and intervention by an ophthalmologist is ideal but emergency physicians (EP) often do not have specialty support in the timeframe required to treat OCS. Therefore, EP should be familiar with lateral canthotomy in case of OCS to minimize the chance of vision loss. Case Presentation We reported a case of 80 years old Caucasian male who had an accidental injury to the right eye that happened around 12:30 pm. Patient self-presented to emergency department (ED) at 1:30 pm with pain and complete loss of vision in right eye. Clinical examination of right eye revealed proptosis, grade IV hyphema and extensive sub conjunctival hemorrhage with visual acuity reduced from 6/18 to light perception in right eye. Although tonometer was not available in ED but on palpation, right eyeball was found to be hard compared to the left. A diagnosis of OCS was made. As the nearest eye center was at 1 hour drive so the decision to perform lateral canthotomy was made after consulting with ophthalmologist in view to save the vision. The procedure was performed in ED under local anesthesia. Pain improved and eyeball felt less hard on repeat palpation. Patient was transferred to eye center. Patient had successful surgery and was discharged. Visual acuity in right eye improved gradually and patient showed significant improvement in vision on subsequent visits. Conclusion This case highlights the importance of emergency lateral canthotomy in event of OCS due to traumatic retro bulbar hemorrhage. The EP encountering such injuries must be able to evaluate, diagnose and treat OCS secondary to retrobulbar hemorrhage.