Fast swelling around the eye with fading sight needs help now
Advice from an emergency physician and an oculoplastic surgeon
After an eye injury, blood or swelling can build up behind the eye. The eye sits in a bony socket, so the pressure in there can climb. In rare cases, the pressure puts the blood supply to the optic nerve and retina at risk. [1, 2]
The eye may seem to bulge out. The lids may feel tight. You may struggle to move the eye or notice your sight fading. Doctors call this orbital compartment syndrome. After a face injury, it is an emergency where every minute counts. [1, 2]
Signs to report the moment you notice them
Tell the emergency staff at once if your vision is getting worse. Also report severe pain around one eye, swelling that grows fast, double vision or an eye that looks pushed forward. Let them know if you take a blood thinner or have had eye surgery. If you’re at home, call emergency services. Do not wait for a regular eye clinic appointment. [1, 2]
How the ER team decides what to do
The team checks your sight, pupils, eye position and eye movement. They measure the pressure in the eye when it’s safe to do so. They also look for an open wound in the eyeball itself. If the exam strongly points to dangerous pressure in the socket, trained doctors may need to release it right away. [1, 2]
A scan can help show the injury. Still, pressure that seems to threaten your sight should not wait for imaging. Do not press on the eye or try to treat it yourself. [1, 2]
After the pressure comes down
Once the pressure is under control, ask what caused it. Find out if the eye or socket was hurt as well and how your vision will be watched. You may need more care for bleeding, a fracture or another eye injury. [1]
What to ask your care team
- What caused the pressure behind my eye?
- Did it affect my retina or optic nerve?
- When will my vision and eye pressure be checked again?
If it's happening right now
Sources and further reading
- 1American Academy of Ophthalmology EyeWiki, orbital compartment syndrome
- 2American Academy of Ophthalmology EyeWiki, pre ophthalmologist management of eye trauma
This article shares general education from emergency medicine and oculoplastic surgery. Painful swelling that comes on fast with a change in vision is an emergency. Only trained doctors should examine or treat pressure behind the eye.
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