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Current Opinion in Otolaryngology & Head & Neck Surgery:
doi: 10.1097/MOO.0b013e32836312a1
MAXILLOFACIAL SURGERY: Edited by Sherard A. Tatum

Management of the ‘tight orbit’ and associated visual loss

Alford, Eugene L.a,b,c,d; Soparkar, Charles N.S.b,c,e,f,g

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Abstract

Purpose of review

To review the most recent literature on the management of the orbit under high pressure (the tight orbit) with threatened visual loss.

Recent findings

Definitive management of traumatic optic neuropathy remains unclear, lacking randomized head-to-head treatment option trials. Instead, numerous case series and anecdotal reports show benefit in each of the four treatment modalities currently in use, but a multitude of variables confound cross-study comparison. In contrast, the management of orbital hemorrhage and orbital emphysema is well known. A number of immunomodulatory protocols have recently arisen for the medical suppression of Graves’ ophthalmopathy, but when surgical decompression is required, most authors currently favor a combined transconjunctival and endoscopic endonasal approach.

Summary

This article reviews the anatomy, pathophysiology, diagnosis, and intervention of the ‘tight orbit’ with associated visual loss. Guidelines for the intervention are given.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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