Best of five
- A. Immediate lateral canthotomy and cantholysis without waiting for imaging
- B. Wait for formal visual-field testing
- C. Apply an eye patch
- D. Reduce the nasal fracture first
- E. Give oral antibiotics and review tomorrow
FRCS (ORL-HNS) · SECTION 1 SBA
Orbital compartment syndrome
After facial trauma, a patient develops rapidly falling vision, a tense proptotic orbit, relative afferent pupillary defect and raised intraocular pressure. What is the immediate action?
A. Immediate lateral canthotomy and cantholysis without waiting for imaging
Orbital compartment syndrome threatens retinal and optic-nerve perfusion. Clinical diagnosis with visual compromise mandates immediate decompression; CT follows when it will not delay treatment.
Why every option is right or wrong
A. Immediate lateral canthotomy and cantholysis without waiting for imaging: Orbital compartment syndrome threatens retinal and optic-nerve perfusion. Clinical diagnosis with visual compromise mandates immediate decompression; CT follows when it will not delay treatment.
B. Wait for formal visual-field testing: Delay risks irreversible blindness.
C. Apply an eye patch: Occlusion does not reduce orbital pressure.
D. Reduce the nasal fracture first: Vision takes priority over skeletal alignment.
E. Give oral antibiotics and review tomorrow: This is a pressure emergency, not routine infection.
What if the scenario changed?
If proptosis were mild with normal vision, pupils and pressure, urgent imaging and observation might precede decompression.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
Back to the Section 1 bank