Orbital Compartment Syndrome after High-speed Air-Gasoline Blast Injury

Zhenyang Zhao, Amina Malik, Nita Bhat, Shruthi Harish Bindiganavile, Rahul T. Pandit, Shaheen C. Kavoussi, Andrew G. Lee

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)E97-E100
JournalOphthalmic Plastic and Reconstructive Surgery
Volume37
Issue number3
Early online dateJun 1 2021
DOIs
StateE-pub ahead of print - Jun 1 2021

Keywords

  • Adult
  • Blast Injuries/etiology
  • Compartment Syndromes/diagnosis
  • Decompression, Surgical
  • Gasoline
  • Humans
  • Male
  • Orbit/surgery
  • Orbital Diseases/surgery

ASJC Scopus subject areas

  • Ophthalmology
  • Surgery

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