A Posttraumatic Dilated, Proptotic Eye Does Not Always Need a Lateral Canthotomy! A Review of Superior Orbital Fissure Syndrome for Emergency Physicians

• Published in: The Journal of emergency medicine Vol. 60; no. 4; pp. 520 - 523
• Main Authors: Bui, Matthew, Ryan, Kevin M., Oke, Isdin, Peeler, Crandall E., Jacquet, Gabrielle A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2021
• Subjects: lateral canthotomy; ocular trauma; ophthalmoplegia; ptosis; superior orbital fissure syndrome; ophthalmoplegia; ocular trauma; lateral canthotomy; superior orbital fissure syndrome; ptosis
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2020.11.021

Superior orbital fissure syndrome (SOFS) is a rare constellation of findings consisting of ophthalmoplegia, ptosis, a fixed dilated pupil, forehead anesthesia, and loss of the corneal reflex. This syndrome, though rare, is most often encountered in trauma with individuals sustaining a facial fracture.
We present a case of a young woman who was diagnosed with SOFS after a fall in her house, hitting her face on a nightstand. Treatment consisted of high-dose i.v. steroids followed by a taper with close follow-up in the Ophthalmology clinic. We provide a brief review of SOFS, including treatment considerations and follow-up.
SOFS can be easily overlooked in an individual presenting to the emergency department after facial trauma with proptosis. However, a thorough examination of the eye, visual acuity, and intraocular pressure will focus the physician on SOFS rather than the need for immediate decompression via lateral canthotomy. This report describes a traumatic cause of SOFS, the pathophysiology and treatment, and summarizes existing literature.