Orbital compartment syndromes following trauma.

The etiology of traumatic optic neuropathy is uncertain, except when intraocular pressure is elevated and CRAO can be observed. Various mechanisms have been implicated, and the etiology probably varies with individual cases. Prognosis is best when vision is initially intact and subsequently deteriorates, suggesting compression that may be reversible. Some authorities recommend high doses of systemic steroids as initial therapy. Anatomically, the orbit is a relatively closed compartment, and significant pressure may develop following intraorbital hemorrhage, edema, or emphysema. When clinical signs of severe orbital hemorrhage and pressure (proptosis) are associated with an optic neuropathy, the clinician is faced with a difficult decision. Mechanical decompression of the orbit is technically within our ability, and considerable positive experience has been derived from the treatment of compressive optic neuropathy in Grave's disease. Although the efficacy of decompression in trauma is uncertain, the literature provides anecdotal reports of restored vision. With full informed consent regarding these issues, orbital decompression seems appropriate for the rare case in which clinical signs of orbital pressure are impressive.