Editing Face injury (section)

== Orbital compartment syndrome ==

* Pathophys
** Susceptible to compartment syndrome due to small size and bony walls
** Bleeding into retrobulbar, subperiosteal, extraconal, and/or intraconal spaces of the orbit can cause rapid orbital distention
** Ischaemia of the orbital tissue can result, leading to damage and permanent vision loss
** Big fractures are protective due to allowing decompression
* Presentation
** Proptosis and taut orbital content, or increased resistance to retropulsion, are always present
** Mild compartment syndrome won't have vision changes or signs of optic nerve compromise
** Intraocular pressure >40mmHg a lateral canthotomy and cantholysis is indicated
* Technique
** Prep and drape
** Anaesthetise with 2% lignocaine with adrenaline in the lateral canthus - infiltrate subcutaneously but don't puncture globe
** Put an artery clamp over the lateral canthus horizontally and leave for one minute to reduce bleeding
** Take scissors with one blade on the skin side and one blade on the conjunctival side and cut the lateral corner of the eyelid while applying lateral pressure. Incise as far as orbital rim
** The inferior crus of the lateral canthal tendon will need to be cut to release the lower eyelid from the lateral orbital wall - use the scissors held directly laterally to strum the inferior tendon inside the cut canthotomy wound, which feels like a firm, tense cord. Now open the blades of the scissors and cut the cordlike structure until the lower eyelid becomes freely mobile, which is again about as far as the edge of globe. 
** Haemostasis will come with pressure or diathermy.

[[Category:Trauma]]