The orbital compartment syndrome (tension orbitus) occurs when there is a sudden increase in intraorbital pressure. This usually involves an increase in intraocular contents with intact orbital walls.



(1) trauma or surgery with hemorrhage

(2) orbital inflammation (cellulitis, pseudotumor)

(3) severe orbital emphysema

(4) thyroid orbitopathy


Clinical features:

(1) sudden proptosis (exophthalmos) over a period of minutes to hours

(2) difficulty opening the eyelids

(3) chemosis (conjunctival edema), which may be hemorrhagic

(4) ocular pain

(5) nausea and vomiting

(6) decreased ocular motility

(7) elevated intra-ocular pressure (> 40 mm Hg)

(8) decreased visual acuity which may progress to acute vision loss

(9) relative afferent pupillary defect


If the pressure continues to increase without relief, then ocular ischemia and optic neuropathy may develop,


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