Ms Michelle Sun, Weng Onn Chan, Simon McRae, Dinesh Selva
To report the first case of bilateral orbital compartment syndrome due to bilateral aseptic cav-ernous sinus thrombosis in a patient with protein C deficiency and concurrent essential thrombocytosis.
A 47-year-old man with protein C defi-ciency and a history of inflammatory bowel disease underwent surgery for debridement of skin necrosis, likely precipitated by the new onset of essential thrombocytosis. Immediately post-operatively, the patient complained of pain, swelling, and dramatically decreased visual acuity (VA) in the left eye. Examina-tion findings included proptosis with limited extra-ocular movements, periocular oedema and chemosis; VA was hand movements. Shortly after, the patient developed similar symptoms in the right eye, and examination findings were similar to that of the left eye, with a VA of no perception to light.
A clinical diagnosis of bilateral orbital com-partment syndrome was made and computed tom-ography revealed changes consistent with bilateral cavernous sinus thrombosis. An emergency canthot-omy and cantholysis was performed for both eyes and high-dose IV steroids were started. Decompression was performed 1.5 hours after onset of symptoms in the left eye, and 3.5 hours after symptoms began in the right. There was no visual recovery beyond hand movements in the right eye, but the left eye recovered a VA of 6/24.
It is important to recognize bleeding dyscaria as a risk factor for the development of orbital compartment syndrome. Surgical decompression should not be delayed when such patients present with symptoms suggestive of orbital venous conges-tion and raised orbital tension.