A 40-year-old man develops severe pain, proptosis, tense eyelids that resist opening, vision drop to light perception, an afferent pupillary defect, and IOP of 48 mmHg one hour after blunt orbital trauma. CT shows a retrobulbar haemorrhage. The most appropriate immediate intervention is:

• A Intravenous mannitol and topical timolol
• B Lateral canthotomy with inferior cantholysis ✓
• C Immediate orbital floor exploration via transconjunctival approach
• D High-dose intravenous corticosteroids

Explanation

Orbital compartment syndrome from retrobulbar haemorrhage threatens the optic nerve within minutes to hours. The definitive bedside decompression is lateral canthotomy with inferior cantholysis, which allows the globe to move forward and lowers orbital pressure. Pressure-lowering drugs are adjuncts only and delay definitive care. Steroids treat traumatic optic neuropathy, not raised orbital pressure, and bone exploration addresses fractures, not haemorrhage.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.