Evaluation of novel guidelines for management of burn patients at risk of orbital compartment syndrome.

PURPOSE: The Burn Orbital Compartment Syndrome guidelines (BOCS) are risk-stratified management guidelines developed to determine eye examination timing and intraocular pressure (IOP) thresholds for surgical intervention in burn patients at risk for orbital compartment syndrome (OCS). The aim of this study is to evaluate the use of BOCS in detecting IOP elevation and preventing vision-threatening OCS in burn patients. METHODS: This retrospective, single-institution case series included facial burn patients managed by ophthalmology using BOCS over 4 years. Patients were divided into High Risk versus Low Risk and Surgical versus Non-surgical groups. High Risk patients had greater than 50% total body surface area (TBSA) involving the face or at least 2 of 3 likely risk factors (vasopressin use, albumin use, or presence of conjunctival chemosis). The Surgical group underwent interventions including canthotomy and cantholysis, septolysis, and/or eyelid split. RESULTS: Among 24 patients, surgical intervention was performed on 61.5% of High Risk patients, while 88.9% of Surgical patients were High Risk. Surgical patients had higher mean %TBSA (61.0% vs 22.3%, p < 0.05) and albumin administration rates (88.9% vs 20%, p < 0.05) compared to the Non-surgical group. Surgical patients presented with mean IOP of 28.4 mmHg (range 11-80) and reached peak IOP (mean 47.8 mmHg) at a mean of 11.8 h (range 5-20) after injury. CONCLUSIONS: Early and frequent IOP monitoring is essential in High Risk burn patients. Eye examinations should occur within 12 h with adjustments in frequency based on risk factors like %TBSA and albumin use.