Two Cases of Rapidly Progressive Vision Loss From Ischemic Reperfusion Injury and Rhabdomyolysis

Orbital compartment syndrome due to rhabdomyolysis and subsequent ischemic reperfusion injury is an extremely rare event. Treatment consists of decreasing intraorbital pressure, which may include emergent surgical decompression and addressing the underlying cause, which in these cases was skeletal muscle injury in the setting of prolonged immobilization. Despite intervention, acute orbital compartment syndrome with visual acuity loss has a poor prognosis if effective therapy is not initiated promptly. To the authors’ knowledge, there is only 1 previously reported case of orbital apex syndrome, and no cases of orbital compartment syndrome caused by rhabdomyolysis after drug-induced loss of consciousness. Here, the authors describe the course of 2 patients with rhabdomyolysis after drug overdose, after tricyclic antidepressant and opiate use, respectively. These patients were suspected of having compressive orbital ischemia that led to extraocular muscle swelling and rebound hyperperfusion, which exacerbated already elevated compartment pressures.