Citation

Mai AP, Fortenbach CR, Wibbenmeyer LA, Wang K, Shriver EM. J. Burn Care Res. 2020; ePub(ePub): ePub.

Affiliation

Department of Ophthalmology and Visual Sciences, Culver College of Medicine, University of Iowa Hospitals and Clinics.

Copyright

(Copyright © 2020, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/iraa053

PMID

32246146

Abstract

Burn patients receiving aggressive fluid resuscitation are at risk of developing orbital compartment syndrome (OCS). This condition results in elevated orbital pressures and can lead to rapid permanent vision loss. Risk factors and monitoring frequency for OCS remain largely unknown. A retrospective review was therefore conducted of admitted burn patients evaluated by the ophthalmology service at an American Burn Association verified Burn Treatment Center. Demographic, burn, examination, and fluid resuscitation data were compared using 2-sided t-tests, Fisher's Exact tests, and linear regression. Risk factors for elevated intraocular pressures (IOPs; a surrogate for intraorbital pressure) in patients resuscitated via the Parkland formula were found to be total body surface area (% TBSA) burned, resuscitation above the Ivy Index (> 250 ml/kg), and Parkland formula calculated volume. Maximum IOP and actual fluid resuscitation volume were linearly related. Analysis of all patients with elevated IOP found multiple patients with significant IOP increases after initial evaluation resulting in OCS within the first 24 hours post-injury. While %TBSA, Ivy Index, and resuscitation calculated volume are OCS risk factors in burn patients, 2 patients with facial burns developed OCS (25% of all patients with OCS) despite not requiring resuscitation. Orbital congestion can develop within the first 24-hours of admission when resuscitation volumes are the greatest. In addition to earlier and more frequent IOP checks in susceptible burn patients during the first day, the associated risk factors will help identify those most at risk for OCS and vision loss.

© The Author(s) 2020. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Language: en

Keywords

Orbital compartment syndrome; blindness; burn; intraocular pressure; resuscitation