2022 Volume 50 Issue 4 Pages 251-259
We reviewed reports of postoperative visual loss (POVL) with an unexplained cause, following neurosurgery, and the possible involvement of orbital compartment syndrome (OCS) as the etiology. OCS is an ophthalmic emergency characterized by an acute increase in orbital pressure. It is likely to be the cause of orbital symptoms, such as eye pain, ophthalmoplegia, eyelid and conjunctival edema, in addition to visual loss, in patients. Of 69 reported cases of POVL, 47 (68.1 %) were considered OCS, including 39 that were reported under other diagnoses. The possibility of mild OCS could not be ruled out in the remaining 22 patients. OCS is clinically diagnosed, and emergent orbital decompression (even prior to imaging) is essential to prevent permanent visual loss. Although good recovery of visual acuity is unlikely if orbital decompression is performed more than 2 hours after onset, there are reports on effectiveness of this treatment after the 2 hours' time window. The early recognition and diagnosis of this condition are extremely important.
Several recent reports have suggested indirect orbital compression and orbital venous perfusion disorder, caused by scalp flap traction, as a mechanism of OCS after craniotomy.
