Canthotomy: Difference between revisions
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**IOP >40 '''or''' marked difference in globe compressibility by palpation | **IOP >40 '''or''' marked difference in globe compressibility by palpation | ||
**Proptosis | **Proptosis | ||
*Secondary indications (subjective and nonspecific) - if only secondary indications are present, get emergent ophthalmology consult prior to performing canthotomy. | |||
**Afferent pupillary defect | |||
**Cherry red macula | |||
**Ophthalmoplegia | |||
**Nerve head pallor | |||
**Significant eye pain | |||
==Contraindications== | ==Contraindications== | ||
Revision as of 04:14, 3 July 2015
Background
- Causes of acute orbital compartment syndrome (OCS)[1]
- Trauma (retrobulbar hematoma) - most common cause
- Spontaneous bleed
- Tumor
- Orbital cellulitis/abscess
- Prolonged hypoxemia
- OCS is a clinical diagnosis
- Vision loss can be permanent after 60-100 min of ischemia[1] - do not delay procedure
Indications[2]
- Suspected acute orbital compartment syndrome (OCS), plus one or more of the following:
- Decreased visual acuity
- IOP >40 or marked difference in globe compressibility by palpation
- Proptosis
- Secondary indications (subjective and nonspecific) - if only secondary indications are present, get emergent ophthalmology consult prior to performing canthotomy.
- Afferent pupillary defect
- Cherry red macula
- Ophthalmoplegia
- Nerve head pallor
- Significant eye pain
Contraindications
- Globe Rupture
Equipment
- Betadine/Iodine prep
- Lidocaine w/epi
- Syringe with 27-30ga needle
- Sterile gloves, face shield, gown
- Sterile drape or towels
- Normal saline for irrigation
- Straight hemostat
- Sterile iris or suture scissors
- Forceps
Procedure
Consider sedating patient for procedure
- prep and drape the area
- inject 1cc of lidocaine with epi into the lateral canthus directing the needle tip toward the lateral orbital rim
- irrigate eye to eliminate debris
- crimp the skin at the lateral corner of the pts eye using a straight hemostat for ~1-2 minutes (make sure to crimp all the way down to the orbital rim)
- lift up the skin around the lateral orbit with forceps and make a 1-2 cm cut with scissors beginning at the lateral corner of the eye and extending laterally
- retract the inferior lid and dissect bluntly until you palpate/visualize the lateral canthus tendon
- cut the inferior crux of the lateral canthus tendon (point scissors infero-posteriorally toward the lateral orbital rim avoiding the globe)
- recheck IOP, if still elevated cut the superior crux of the tendon
Complications
- iatrogenic globe/tendon/lacrimal duct injury
- loss of adequate lower lid suspension
- bleeding
- infection
- fibrosis
- vision loss