Purpose of Review: To review the most recent literature on the management of the orbit under high pressure (the tight orbit) with threatened visual loss. Recent Findings: Definitive management of traumatic optic neuropathy remains unclear, lacking randomized head-to-head treatment option trials. Instead, numerous case series and anecdotal reports show benefit in each of the four treatment modalities currently in use, but a multitude of variables confound cross-study comparison. In contrast, the management of orbital hemorrhage and orbital emphysema is well known. A number of immunomodulatory protocols have recently arisen for the medical suppression of Graves' ophthalmopathy, but when surgical decompression is required, most authors currently favor a combined transconjunctival and endoscopic endonasal approach. Summary: This article reviews the anatomy, pathophysiology, diagnosis, and intervention of the 'tight orbit' with associated visual loss. Guidelines for the intervention are given.

Original languageEnglish (US)
Pages (from-to)417-422
Number of pages6
JournalCurrent Opinion in Otolaryngology and Head and Neck Surgery
Issue number4
StatePublished - Aug 2013


  • Graves' disease
  • optic nerve
  • orbital emphysema
  • orbital hemorrhage
  • traumatic optic neuropathy
  • visual loss

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery


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