Orbital compartment syndrome mimicking cerebral herniation in a 12-yr-old boy with severe traumatic asphyxia

Objective: To report a case of orbital compartment syndrome mimicking cerebral herniation in a boy with severe traumatic asphyxia. Design: Case report. Setting: A tertiary-care pediatric intensive care unit. Subject: A 12-yr-old boy with traumatic asphyxia syndrome. Intervention: Mechanical ventilation, chest tube drainage, nitric oxide, lateral canthotomies, intracranial pressure monitoring. Measurements and Main Results: A patient is presented with severe traumatic asphyxia syndrome complicated by prolonged hypoxemia, massive capillary leak syndrome, and acute onset of pupillary dilation and loss of reactivity to light. Ophthalmologic examination confirmed bilateral orbital compartment syndrome, which was treated emergently with bilateral canthotomies at the bedside. The procedure was followed by prompt return of pupillary size and function and decrease in intraocular pressure. The patient experienced complete recovery of vision in the right eye, but vision in the left eye was severely impaired. Conclusions: Our case report emphasizes the importance of considering orbital compartment syndrome in patients with traumatic asphyxia syndrome. Recognition of orbital compartment syndrome is important in this setting because prompt operative intervention may reduce the likelihood of permanent vision loss.