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.
aAlford Facial Plastic Surgery
bWeill Cornell College of Medicine
cBaylor College of Medicine
dDepartment of Otolaryngology, The Methodist Hospital
ePlastic Eye Surgery Associates
fMD Anderson Cancer Center
gDepartment of Ophthalmology, The Methodist Hospital, Houston, Texas, USA
Correspondence to Eugene L. Alford, MD, FACS, 6560 Fannin Suite 704, Houston, TX 77030, USA. Tel: +1 713 532 3223; fax: +1 713 799 8821; e-mail: Ealford@tmhs.org