Management of the 'tight orbit' and associated visual loss

Curr Opin Otolaryngol Head Neck Surg. 2013 Aug;21(4):417-22. doi: 10.1097/MOO.0b013e32836312a1.


Purpose of review: To review the most recent literature on the management of the orbit under high pressure (the tight orbit) with threatened visual loss.

Recent findings: Definitive management of traumatic optic neuropathy remains unclear, lacking randomized head-to-head treatment option trials. Instead, numerous case series and anecdotal reports show benefit in each of the four treatment modalities currently in use, but a multitude of variables confound cross-study comparison. In contrast, the management of orbital hemorrhage and orbital emphysema is well known. A number of immunomodulatory protocols have recently arisen for the medical suppression of Graves' ophthalmopathy, but when surgical decompression is required, most authors currently favor a combined transconjunctival and endoscopic endonasal approach.

Summary: This article reviews the anatomy, pathophysiology, diagnosis, and intervention of the 'tight orbit' with associated visual loss. Guidelines for the intervention are given.

Publication types

  • Review

MeSH terms

  • Decompression, Surgical / methods
  • Emphysema / diagnosis
  • Emphysema / physiopathology
  • Emphysema / therapy*
  • Eye Hemorrhage / diagnosis
  • Eye Hemorrhage / physiopathology
  • Eye Hemorrhage / therapy*
  • Graves Ophthalmopathy / diagnosis
  • Graves Ophthalmopathy / physiopathology
  • Graves Ophthalmopathy / therapy*
  • Humans
  • Optic Nerve Diseases / diagnosis
  • Optic Nerve Diseases / physiopathology
  • Optic Nerve Diseases / therapy*
  • Vision Disorders / prevention & control*