{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:57Z","timestamp":1787028657663,"version":"build-2736575974"},"reference-count":24,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: Various orbital conditions (trauma, autoimmune thyroid disease, tumors, infections, congenital malformations) may lead to a consecutive increase in orbital cavity pressure resulting in orbital compartment syndrome (OCS). OCS is associated with acute loss of visual function and a high risk of permanent damage to the optic nerve (compressive optic neuropathy). Orbital decompression surgery (ODS) is a time-critical procedure that reduces pressure on the optic nerve, thereby improving visual function. The surgical management protocol for orbital decompression is not standardized and varies. Surgical techniques differ in orbital fat decompression, lateral canthotomy, and decompression of the medial orbital wall and floor. This retrospective study aims to evaluate surgery procedures and the outcome of visual function after orbital decompression surgery. Methods: In this retrospective study, we evaluated 28 patients (17 male, 11 female) with orbital compartment syndrome from May 2016 to October 2024. All patients underwent orbital decompression surgery as first-line treatment. Visual acuity (VA), diplopia, and ocular motility were analyzed pre- and postoperatively. Recovery was defined as postoperative improvement of vision, diplopia, and ocular motility. Linear and logistic regression analyses were used to assess the associations between clinically relevant risk factors and primary outcomes. Results: Orbital decompression surgery was performed with a median of 8.40 h (Q1: 4.80, Q3: 24.00) upon occurrence of symptoms. The average preoperative measured VA (logMAR) of the affected eye was 1.0. A total of 46% of the patients were preoperatively categorized as \u201dblind\u201c according to the WHO visual impairment categories. A total of 96% of the patients showed preoperative ocular motility impairment. Diplopia was preoperatively present in 46% of the patients. After orbital decompression surgery, postoperative visual acuity improved in 36% of the patients. Ocular motility improved by 67% and diplopia by 62% after ODS. The primary surgery technique was two-wall decompression in 68% (19\/28) of the cases, followed by one-wall decompression (21%; 6\/28), and three-wall decompression (11%; 3\/28). Lateral decompression (82%; 23\/28) and medial wall decompression (93%; 26\/28) were the primary procedures performed. Orbital floor wall decompression was performed in only 14% (4\/28) of the cases. Regression analysis revealed a statistically significant effect of preoperative measured vision on postoperative vision, while accounting for age, sex, and time to surgery. Conclusions: Orbital decompression surgery is the time-sensitive first-line treatment of acute visual function loss in OCS. Our data showed a postoperative improvement in visual acuity in 36% of the patients, along with considerable improvement rates in diplopia and ocular motility. The primary surgery technique was a two-wall decompression approach with lateral wall decompression and medial wall decompression. Center-specific timeline optimization of OCS patients is essential.<\/jats:p>","DOI":"10.3390\/jcm14103453","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T06:10:44Z","timestamp":1747289444000},"page":"3453","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Decompression Surgery of Orbital Compartment Syndrome\u2014Analysis of Surgery Procedures and Visual Function"],"prefix":"10.3390","volume":"14","author":[{"given":"Alexander","family":"Kilgue","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Bielefeld University, Campus Klinikum Bielefeld Mitte, Teutoburgerstr. 50, 33604 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1624-0367","authenticated-orcid":false,"given":"Christoph","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Bielefeld University, Campus Klinikum Bielefeld Mitte, Teutoburgerstr. 50, 33604 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars-Uwe","family":"Scholtz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Bielefeld University, Campus Klinikum Bielefeld Mitte, Teutoburgerstr. 50, 33604 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrad","family":"Riemann","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Bielefeld University, Campus Klinikum Bielefeld Mitte, Teutoburgerstr. 50, 33604 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Hoyer","sequence":"additional","affiliation":[{"name":"Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, 33604 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maged","family":"Alnawaiseh","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Medical School OWL, Bielefeld University, Campus Klinikum Bielefeld Mitte, 33604 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4161-8304","authenticated-orcid":false,"given":"Ingo","family":"Todt","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Bielefeld University, Campus Klinikum Bielefeld Mitte, Teutoburgerstr. 50, 33604 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/00006534-195009000-00005","article-title":"Monocular blindness as a complication of the treatment of malar fracture","volume":"6","author":"Gordon","year":"1950","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/00002341-199612000-00009","article-title":"Optic neuropathy following simulation of orbital hemorrhage in the nonhuman primate","volume":"12","author":"Hargaden","year":"1996","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/S0266-4356(96)90004-2","article-title":"Treatment of retrobulbar haemorrhage in accident and emergency departments","volume":"34","author":"Hislop","year":"1996","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/S0196-0709(96)90019-8","article-title":"Ophthalmic complications of endoscopic ethmoid surgery and their management","volume":"17","author":"Dunya","year":"1996","journal-title":"Am. J. Otolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"111824","DOI":"10.1016\/j.ijporl.2023.111824","article-title":"Visual outcomes following orbital decompression for orbital infections","volume":"176","author":"Bliss","year":"2024","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1016\/j.joms.2008.04.012","article-title":"Acute proptosis in trauma: Retrobulbar hemorrhage or orbital compartment syndrome\u2014Does it really matter?","volume":"66","author":"Perry","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1136\/bjo.64.11.818","article-title":"Experimental occlusion of the central artery of the retina. IV: Retinal tolerance time to acute ischaemia","volume":"64","author":"Hayreh","year":"1980","journal-title":"Br. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/1742-6723.12236","article-title":"Traumatic orbital compartment syndrome: Importance of the lateral canthomy and cantholysis","volume":"26","author":"Sun","year":"2014","journal-title":"Emerg. Med. Australas."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1136\/emermed-2018-207937","article-title":"Management of acute retrobulbar haemorrhage: A survey of non-ophthalmic emergency department physicians","volume":"36","author":"Edmunds","year":"2019","journal-title":"Emerg. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1016\/S0196-0644(05)82750-7","article-title":"Evaluation and significance of the pupillary light reflex in trauma patients","volume":"22","author":"Meyer","year":"1993","journal-title":"Ann. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1016\/j.jcms.2015.05.003","article-title":"Update on orbital decompression as emergency treatment of traumatic blindness","volume":"43","author":"Soare","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_12","unstructured":"(2025, May 09). Available online: https:\/\/icd.who.int\/browse10\/2019\/en#\/H54."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.bjps.2017.10.025","article-title":"Retrobulbar hematoma: A systematic review of factors related to outcomes","volume":"71","author":"Christie","year":"2018","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1001\/archopht.121.4.491","article-title":"Idiopathic Orbital Inflammation: Distribution, Clinical Features, and Treatment Outcome","volume":"121","author":"Yuen","year":"2003","journal-title":"Arch. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1016\/j.ijom.2012.09.024","article-title":"Orbital haemorrhage associated with orbital fractures in geriatric patients on antiplatelet or anticoagulant therapy","volume":"42","author":"Maurer","year":"2013","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e464","DOI":"10.1016\/j.joms.2012.05.007","article-title":"Traumatic and iatrogenic retrobulbar hemorrhage: An 8 patient series","volume":"70","author":"Colletti","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"26","DOI":"10.55460\/1CLD-XJUV","article-title":"Emergency lateral canthotomy and cantholysis: A simple procedure to preserve vision from sight threatening orbital haemorrhage","volume":"9","author":"Ballard","year":"2009","journal-title":"J. Spec. Oper. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/S0736-4679(01)00477-2","article-title":"Traumatic retrobulbar hemorrhage: Emergent decompression by lateral canthotomy and cantholysis","volume":"22","author":"Vassallo","year":"2002","journal-title":"J. Emerg. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1034\/j.1600-0420.1999.770225.x","article-title":"Acute orbital compartment syndrome after lateral blow-out fracture effectively relieved by lateral cantholysis","volume":"77","author":"Larsen","year":"1999","journal-title":"Acta Ophthalmol. Scand."},{"key":"ref_20","first-page":"1","article-title":"Orbital Compartment Syndrome","volume":"4","author":"Turgut","year":"2019","journal-title":"Beyoglu Eye J."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Khasnabish, I., Chikwinya, T., and Muscente, J. (2024). Orbital Compartment Syndrome. Complex Cases in Clinical Ophthalmology Practice, Springer.","DOI":"10.1007\/978-3-031-73467-0"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.2147\/OPTH.S180058","article-title":"Orbital Compartment Syndrome: An Update with Review of the Literature","volume":"13","author":"McCallum","year":"2019","journal-title":"Clin. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1097\/00006982-199010001-00005","article-title":"Prediction of postoperative vision in eyes with severe trauma","volume":"10","author":"Fuller","year":"1990","journal-title":"Retina"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s10006-021-01036-9","article-title":"Acute orbital compartment syndrome due to traumatic hemorrhage: 4-year case series and relevant literature review with emphasis on its management","volume":"27","author":"Papadiochos","year":"2023","journal-title":"Oral. Maxillofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3453\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:33:05Z","timestamp":1760031185000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3453"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,15]]},"references-count":24,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14103453"],"URL":"https:\/\/doi.org\/10.3390\/jcm14103453","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,15]]}}}