Recurrent orbital compartment syndrome caused by a blow-out fracture and accumulation of air; Management by orbital punctures

摘要

A 46-year-old moderately myopic man (-6 D) with a past history of Graves' disease, preseptal cellulitis and a left-sided peri-orbital haema-toma arising from injury 7 years ago presented with another episode of orbital floor fracture, mild orbital emphysema (Fig. 1A) and microhy-phaema in the left eye. On the day of presentation, the visual acuity (VA) remained unaffected (6/6) in both eyes. However, on day 2, the VA of his left eye was reduced to hand movement. The left eye was proptotic, Hertel measurements were 23/30-110, motility was reduced and a relative afferent pupillary defect was present (Fig. IB). Orbital haemorrhage or emphysema was suspected, and an emergency lateral canthotomy with severing of the lateral canthal ligament was performed. A computer tomography (CT) scanning revealed a large amount of air in the orbit (Fig. 1C), and punctures with an 18-gauge venous cannula through the upper (Fig. ID) and lower lids were performed under local infiltration anaesthesia with the use of the CT scanning as a guide.