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Elevated Orbital Pressure: Another Untoward Effect of Massive Resuscitation after Burn Injury

Sullivan, Stephen R. MD; Ahmadi, Arash J. MD; Singh, Christopher N. MD; Sires, Bryan S. MD, PhD; Engrav, Loren H. MD; Gibran, Nicole S. MD; Heimbach, David M. MD; Klein, Matthew B. MD

The Journal of Trauma: Injury, Infection, and Critical Care: January 2006 - Volume 60 - Issue 1 - p 72-76
doi: 10.1097/01.ta.0000197657.25382.b2
Original Articles

Background: Fluid resuscitation remains a fundamental component of early burn care management. However, recent studies suggest that excessive volumes of resuscitation are being administered. Overresuscitation results in negative sequelae including abdominal and extremity compartment syndromes. Elevated intraocular pressure (IOP) has been described as another potentially devastating effect of massive fluid resuscitation in trauma patients. The orbit, similar to the abdomen and extremity, is a compartment, limited to expansion from edema anteriorly by the eyelids and orbital septum, and posteriorly by the bony orbital walls. The purpose of this study was to review the incidence of elevated IOP in a series of patients with major burn injury.

Methods: We retrospectively reviewed the charts of 13 consecutive patients admitted to our burn center with burn sizes >25% total body surface area (TBSA). All patients underwent serial IOP measurements for the first 72 hours following admission. Medical records were reviewed for fluid resuscitation volume, IOP measurements, need for canthotomy, and results of canthotomy procedures.

Results: Five of 13 patients had IOP >30 mm Hg and required lateral canthotomy. Canthotomy immediately reduced IOP (p = 0.009). Patients who developed elevated IOP received a significantly larger fluid resuscitation (9.0 cc/kg/%TBSA versus 6.0 cc/kg/%TBSA, p = 0.02). Elevated IOP was significantly associated with delivery of larger fluid resuscitation volume (p = 0.027).

Conclusions: Massive fluid resuscitation following burn injury can result in orbital compartment syndrome requiring lateral canthotomy. Early diagnosis and treatment of orbital compartment syndrome should be incorporated into the management of patients with major burn injury receiving large fluid resuscitation volume.

From the Division of Plastic and Reconstructive Surgery (S.R.S., L.H.E., M.B.K); Department of Ophthalmology (A.J.A., C.N.S., B.S.S.); Department of Surgery (L.H.E., N.S.G., D.M.H., M.B.K.); and the Department of Otolaryngology–Head and Neck Surgery (B.S.S.); Harborview Medical Center, University of Washington, Seattle, Washington.

Submitted for publication August 17, 2005.

Accepted for publication October 14, 2005.

Address for reprints: Matthew B. Klein, MD, University of Washington, Department of Surgery, Division of Plastic Surgery, Harborview Medical Center, Box 359796, 325 Ninth Avenue, Seattle, WA 98104; email:

© 2006 Lippincott Williams & Wilkins, Inc.