Unilateral Orbital Compartment Syndrome with Cavernous Sinus Thrombosis after Prolonged Prone Position Anaesthesia for Spinal Surgery

Abstract

Orbital compartment syndrome is a rare but preventable cause of blindness. A 42 year male patient, a case of accidental fracture cervical spine and quadriplegia underwent cervical spine surgery under general anaesthesia. Surgery was performed with patient in prone position on a padded horse shoe stand for 4 hours duration.Proptosis, redness and chemosis of right eye was noticed 3 hours after recovery from general anaesthesia. The affected eye was stony hard with corneal oedema, fixed dilated pupil, total ophthalmoplegia and absent perception of light. Other eye was unaffected. An urgent canthotomy and cantholysis was done and topical as well as systemic antiglaucoma treatment instituted along with systemic and topical antibiotics. A contrast-enhanced computed tomography, done the next day revealed anterior displacement with posterior tenting of right globe and bilateral cavernous sinus thrombosis. Proptosis and swelling subsided gradually without any recovery of vision. Generalised retinal atrophy and secondary optic atrophy was seen 3 weeks post surgery.