Elsevier

Ophthalmology

Volume 113, Issue 1, January 2006, Pages 105-108
Ophthalmology

Case Report
Ischemic Orbital Compartment Syndrome as a Complication of Spinal Surgery in the Prone Position

https://doi.org/10.1016/j.ophtha.2005.09.025Get rights and content

Objectives

To report a patient with ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position.

Design

Interventional case report.

Methods

An 80-year-old man underwent a prolonged lumbar decompression laminectomy for spinal stenosis, under general anesthesia in the prone position. Several hours later, the patient complained of left periocular pain and reduced vision. Examination revealed significant facial edema, left proptosis, and a tight orbit, as well as no light perception and elevated intraocular pressure in the left eye, with complete internal and external ophthalmoplegia.

Main Outcome Measures

Clinical course, imaging findings, management, and final outcome.

Results

Magnetic resonance imaging confirmed the clinical diagnosis of a compartment syndrome with elevated intraorbital tension. A lateral canthotomy and cantholysis were performed, and high-dose IV steroids were started. The proptosis and facial swelling subsided gradually, but no improvement was noted in left visual acuity or left ocular movements.

Conclusion

It is important to be familiar with this rare complication after prolonged surgery in the prone position. Although the prognosis seems to be poor, it is essential to monitor these patients perioperatively and to intervene surgically and medically once the diagnosis of orbital compartment syndrome is established.

Section snippets

Case Report

An 80-year-old man, with no significant systemic or ocular diseases, underwent an 8-hour L3–L5 decompression laminectomy for lumbar spinal stenosis, under general anesthesia in the prone position. Intraoperatively, his head was supported on a silicone head rest (Fig 1). On extubation, some facial and periorbital swelling was noted. Several hours later, the patient complained of significant left periocular pain and reduced vision. Examination revealed facial edema with 4 mm of left proptosis and

Discussion

In performing spinal surgery on a patient who is placed in the prone position, the patient’s face is supported by a soft headrest device that is designed to secure the head while minimizing pressure on facial structures, especially the globes. It is estimated that the incidence of visual disturbances and blindness after anesthesia for these major surgical procedures varies between 0.05% and 1%.3 Stevens et al4 reviewed the ophthalmic complications in 3450 patients who underwent spinal surgeries

References (11)

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Manuscript no. 2005-348.

The authors state that no conflicting relationships exist, and that no financial support was obtained for the article.

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