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

Rupin N Parikh; Chau Pham; Julia Fleecs; Jamie Keen; Grace Lee; Keith D Carter; Samuel W Jones; Lucy Wibbenmeyer; Erin M Shriver

doi:10.1080/01676830.2026.2730251

Back

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

Journal article

Peer reviewed

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

Rupin N Parikh, Chau Pham, Julia Fleecs, Jamie Keen, Grace Lee, Keith D Carter, Samuel W Jones, Lucy Wibbenmeyer and Erin M Shriver

Orbit (Amsterdam)

09/13/2026

DOI: 10.1080/01676830.2026.2730251

PMID: 42733112

View Online

Abstract

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.

Burn

intraocular pressure

orbital compartment syndrome

Details

Title: Subtitle: Evaluation of novel guidelines for management of burn patients at risk of orbital compartment syndrome
Creators: Rupin N Parikh - University of Iowa
Chau Pham - University of Iowa
Julia Fleecs - University of Iowa
Jamie Keen - University of Iowa
Grace Lee - New York Eye and Ear Infirmary
Keith D Carter - University of Iowa
Samuel W Jones - University of Iowa
Lucy Wibbenmeyer - University of Iowa
Erin M Shriver - University of Iowa
Resource Type: Journal article
Publication Details: Orbit (Amsterdam)
DOI: 10.1080/01676830.2026.2730251
PMID: 42733112
NLM abbreviation: Orbit
ISSN: 1744-5108
eISSN: 1744-5108
Publisher: Taylor & Francis; PHILADELPHIA
Grant note: The University of Iowa Department of Ophthalmology and Visual Sciences
The University of Iowa Department of Ophthalmology and Visual Sciences received an unrestricted grant from the Research to Prevent Blindness Inc., New York, NY. The funding organization has no role in the design or conduct of this research.
Language: English
Electronic publication date: 09/13/2026
Academic Unit: Surgery; Injury Prevention Research Center; Otolaryngology; Ophthalmology and Visual Sciences
Record Identifier: 9985226062402771

Metrics

1 Record Views