DR. DIPIKA SAINATH

DR. MATHU KRISHNAN VALLINAYAGAM

Abstract

Orbital compartment syndrome following blunt trauma is typified by an acute onset of proptosis and tight orbit, retrobulbar haemorrhage (RBH) being the principal cause. A nine-year-old boy with blunt trauma to left eye presented with sudden onset of pain and dramatic visual loss. Visual acuity was documented as perception of light. Examination revealed ecchymosis of eyelids, haemorrhagic chemosis, complete restriction of extraocular movements, exposure keratopathy and relative afferent pupillary defect (RAPD). A hazy view of the fundus revealed a normal optic disc. Though features favoured RBH, absence of “tight orbit” invoked suspicion. Computed tomography (CT) unveiled a haematoma in the superonasal aspect of orbit with tenting of posterior aspect of globe and altered globe contour, suggesting posterior globe rupture. This case highlights that an occult globe rupture should be suspected in traumatic proptosis with a “not so tight” orbit.