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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

Current Opinion in Otolaryngology & Head and Neck Surgery: August 2013 - Volume 21 - Issue 4 - p 417–422
doi: 10.1097/MOO.0b013e32836312a1
MAXILLOFACIAL SURGERY: Edited by Sherard A. Tatum

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:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins