Vertical Lid Split Orbitotomy for Management of Orbital Compartment Syndrome—A Clinical Case Series

Purpose: This study aims to investigate the early use of a vertical lid split orbitotomy for the management of orbital compartment syndrome. Methods: This was a retrospective study of all patients in our center who had a vertical lid split procedure for orbital compartment syndrome. Intraocular pressure was measured before and after completion of the procedure as a surrogate for orbital pressure. Information regarding the mechanism of injury as well as the ophthalmic exam was reviewed. Results: Ten patients were included, 3 of which were bilateral, for a total of 13 eyes. The average age of the patients was 46.4 years (19–2 years). Gunshot wounds were the most common mechanism of injury (40%). Five eyes in 4 patients had prior failed canthotomy and cantholysis prior to presentation by an outside provider. The average intraocular pressure prior to intervention was 52.5 mm Hg (39–60 mm Hg). Average postintervention intraocular pressure was 21.7 mm Hg, with all patients achieving adequate reduction of pressure below 30 mm Hg (15–27 mm Hg). This resulted in an average reduction in pressure of 30.8 mm Hg (20–36 mm Hg), or 58.7%. No patients in the study had iatrogenic globe injury. Conclusions: Orbital compartment syndrome poses a time-sensitive threat to vision. This is the first study of the use of the vertical lid split to decompress the orbit in a clinical setting.