A Rare Cause Of Orbital Compartment Syndrome: Gunshot Injury

Background: To our knowledge, there are no reported orbital compartment syndrome (OCS) cases caused by a foreign body in the orbit accompanying retrobulbar bleeding after gunshot injury.
Case: A 44-year-old male patient presented to our emergency room with gunshot injury, stating a bullet hit his right eye approximately 20 minutes before the visit. Single bullet entry hole was visible on the lateral side of his right lower eyelid. Proptosis, ecchymosis, edema, conjunctival chemosis and lateral strabismus were present in the patient’s right eye. Tonicity of the right eye was found to be slightly increased on palpation and the patient was considered to have OCS. A computed tomography (CT) was performed, which revealed retrobulbar hemorrhage and a bullet fragment stuck in the orbital posterior wall. Anti-edema treatment was initiated and lateral canthotomy/cantholysis was planned for the patient. Another orbital CT showed perforation in the injured eye. Patient was re-evaluated by ophthalmology and neurosurgery specialists, and foreign body (bullet nucleus) in the retrobulbar region was removed by neurosurgery specialist. Patient was discharged with recommendations from the neurosurgery ward after 5 days.
Conclusion: OCS can occur as a rare complication of a gunshot injury. Eye tonicity of patients with firearm injuries to ocular area should be evaluated at frequent intervals and the need for cantatomy or cantolysis should be considered with a multidisciplinary approach in this setting.