216 Risk Stratification of Orbital Compartment Syndrome: A Comparison of Intra-Ocular Pressure and the Baux Score

Abstract

Early fluid resuscitation is a mainstay in acute burn care. Aggressive fluid therapy in significant thermal burns can lead to third spacing of fluid into the orbit thus increasing the risk of orbital compartment syndrome. The Baux score is a simple tool often used in burn care to help predict mortality and thus indicate severity of the burn. This study aims to quantify the intra-ocular pressures (IOP) as it relates to the patient’s Baux score, in an effort to stratify the risk for orbital compartment syndrome. This study is a retrospective analysis of 70 patients with thermal burns at a level one burn center. The initial Baux score was noted for each patient as well as the highest measured IOP within the first 72 hour period. Linear regression was used to test for an association between peak intraocular pressure and the Baux score. Patients requiring orbital decompression were compared with those who did not, using the Fisher exact test. Eleven of 70 patients required emergent orbital decompression with a lateral canthotomy and cantholysis and had a higher Baux score than patients who did not receive the procedure (p = 0.03). The average IOP was 18.7 +/- 5mmHg but patients who underwent an orbital decompression all had IOP greater than 40. There was a positive relationship between the Baux score and IOP for Baux scores greater than 70; however, this was no longer statistically significant when adjusted for periocular burns. The risk of orbital compartment syndrome linearly increases with beaux scores greater than 70 and additionally in patients with periocular burns. As such, a high index of suspicion and early evaluation by an ophthalmologist is warranted in these patients to preserve vision. An elevated Beaux score can predict the necessity for ophthalmic intervention in patients at a high risk for vision loss secondary orbital compartment syndrome