Fenzl Carlton R, Golio Dominick
From the *Department of Ophthalmology, Jamaica Hospital Medical Center/NYMC, Jamaica, New York; †Department of Ophthalmology and Department of Surgery, Division of Plastic Surgery, Brookdale Hospital Medical Center, Brooklyn, New York; ‡Department of Surgery, Division of Plastic Surgery and Ophthalmology, Coney Island Hospital, Brooklyn, New York; §Department of Surgery, Division of Plastic Surgery, Sound Shore Medical Center, New York Medical College, New Rochelle, New York; and ∥Department of Surgery, St. George's University, Grenada, West Indies.
J Craniofac Surg. 2014 Jul;25(4):1358-61. doi: 10.1097/SCS.0000000000000817.
Postoperative orbital compartment syndrome is a potentially blinding complication of surgery in the orbital region. We describe the technique of orbital drain placement as a method of preventing vision loss resulting from orbital compartment syndrome.
We present a retrospective case series of 29 patients who underwent orbital fracture, facial fracture, and orbital implant removal from 7/4/2008 to 5/3/2013 by the same craniofacial surgeon. An orbital drain was placed in each patient. The drainage was recorded daily until drain removal. Criteria for removal included less than or equal to 5 mL of drainage in 24 hours.
Of the 29 patients included in this study, 21 were men and 8 were women. Ages ranged from 17 to 67 years. The postoperative drainage ranged from less than 1 mL to 71 mL of serosanguinous fluid. All drains were removed between the first and sixth postoperative days. No postoperative visual loss, infections, or additional antibiotics were recorded with follow-up reaching as far as 40 months.
Postoperative orbital compartment syndrome is a dangerous complication of surgery in the orbital region. Its rapid onset necessitates immediate intervention to prevent permanent vision loss. Morphologic changes to the optic nerve as well as reductions in electroretinogram a- and b-wave amplitudes have been demonstrated with as little as 7 mL of fluid accumulation. Intraoperative orbital drain placement should be considered in all patients undergoing surgery in the orbital region as a preventative measure.
