Case Report
Orbital compartment syndrome following aneurysm surgery

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Abstract

Orbital compartment syndrome (OCS) is a rare cause of blindness following intracranial surgery. We report a patient with OCS following intracranial cerebrovascular surgery precipitated by severe straining. OCS occurred due to a rapid increase in intraorbital pressure within the rigid confines of the orbit causing hypoperfusion of critical neural structures, which resulted in visual loss and a complete external ophthalmoplegia. Treatment involved urgent surgical soft tissue decompression of the orbit, corticosteroids and osmotic agents. It is important to consider OCS as a cause of blindness in the neurosurgical postoperative setting as without rapid treatment this condition has a very poor prognosis.

Introduction

Visual failure due to orbital compartment syndrome (OCS) is a rare condition characterised by increased intraorbital pressure and subsequent hypoperfusion of critical neural structures and usually associated with external ophthalmoplegia. This syndrome has a very poor prognosis if not recognised and treated rapidly. The following case highlights the occurrence of OCS in the uncommon setting of a recent intracranial cerebrovascular surgery.

Section snippets

Case report

A 58-year-old male presented for an elective craniotomy and clipping of an anterior communicating artery aneurysm. The patient had been diagnosed after investigation of multiple episodes of intermittent vertical diplopia for which he had seen an ophthalmologist and been found to have uncorrected visual acuities of right 6/5 (6/4 with hypermetropic correction), left 6/4, with a normal intraocular pressure, physiologically deep optic disc cups with normal visual fields and intact extra-ocular

Discussion

OCS is a rare ophthalmological emergency characterised by an acute rise in orbital pressure and may result in complete irreversible blindness if not rapidly treated.1 It occurs as a result of acute increase in volume within the confined space of the orbit, which results in a sudden increase in intraorbital pressure causing ischaemia of the orbital structures. There are fewer than 100 cases of OCS reported occurring secondary to a wide variety of aetiologies.1 Fewer than 10 patients with this

Conclusion

This report highlights a rare cause of severe blindness, which may have been precipitated by severe straining in the setting of intracranial surgery in a patient with known preoperative proptosis. We advocate early surgical decompression with adjunctive medical treatments such as corticosteroids and osmotic agents; however, the efficacy of these treatments remains unclear. Electrodiagnostics and OCT may be useful in the diagnosis of OCS, and in particular may aid in prognostication of vision

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      OCS is characterized by increased intraorbital pressure and subsequent hypoperfusion of critical neural structures and is usually associated with external ophthalmoplegia. This syndrome has a poor prognosis if not recognized and treated rapidly.1-9 We report a case of postoperative OCS following a frontotemporal craniotomy and review pertinent literature.

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