Bilateral orbital compartment syndrome and blindness after cerebral aneurysm repair surgery

A 56-year-old man who underwent surgical clipping of a cerebral aneurysm via a bifrontal craniotomy in a Jack-knife position complained of bilateral blindness immediately after surgery. Examinations 14 hours later revealed marked bilateral proptosis with eyelid edema and conjunctival chemosis. MRI demonstrated severe bilateral globe tenting with marked orbital tissue edema. Despite emergent lateral canthotomy and cantholysis, there was no visual recovery. This is a rare case of bilateral irreversible blindness after cerebrovascular surgery caused by orbital compartment syndrome and resulting in severe globe tenting and ocular ischemia. Attention to factors such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection and monitoring may reduce the risk of this complication or allow faster management when diagnosed.