200 Monitoring Intra-ocular Pressure in Burn Patients Undergoing Fluid Resuscitation: A Survey of Practice Patterns

Abstract

Orbital compartment syndrome (OCS) is a rare but devastating complication of over-resuscitation in burn patients that may lead to permanent visual loss. Diagnosis is performed at the bedside by measuring the intra-ocular pressure (IOP). If recognized early, OCS can be treated by lateral canthotomy. The purpose of this study was to survey practice patterns of monitoring IOP and performing canthotomy during burn resuscitation. An eight-question electronic survey was distributed to “all physician members” of the American Burn Association between April and June 2018. Two follow-up reminder emails were sent to encourage participation. Eighty-three responses were received (14 % response rate). IOP was routinely measured by 23% of respondents during acute burn resuscitation. Of those respondents, the most common criteria to initiate IOP measurements were deep peri-orbital burns (74%), total burn size (68%), and the volume of resuscitation (63%). Ophthalmology services were primarily responsible for measuring IOP (84%), and there was a range of described frequencies (every four hours to daily) and durations (one to four days) to monitor these patients. The most frequent indications for decompression of the orbit were IOP > 30 mmHg (54%), deep peri-orbital burns (30%), concurrent abdominal compartment syndrome (7%), and the recommendation of the Ophthalmology Consultant (6%). Canthotomy was performed more often by an ophthalmologist (60%) than by a burn surgeon (18%). Of the respondents, 22% indicated that a burn patient treated at their facility had experienced partial or complete visual loss from suspected orbital compartment syndrome. IOP during acute burn resuscitation does not appear to be routinely monitored. The Ophthalmology service most commonly monitors IOP and most often performs orbital decompression when indicated. No clear pattern emerged for the frequency or duration of monitoring patients for OCS. This is the first study to describe practice patterns of monitoring IOP during burn resuscitation. There exists an opportunity to develop guidelines in collaboration with Ophthalmology to identify patients at risk for OCS with the aim of early intervention and prevention of serious ocular complications.