Canthotomy: Difference between revisions
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**Prolonged hypoxemia | **Prolonged hypoxemia | ||
*OCS is a clinical diagnosis | *OCS is a clinical diagnosis | ||
**Vision loss can be permanent after 60-100 min of ischemia<ref name="JEM" /> - do not delay procedure | **Vision loss can be permanent after 60-100 min of ischemia<ref name="JEM" /> - do not delay procedure for imaging<ref>Mohammadi F, Rashan A, Psaltis A, et al. Intraocular Pressure Changes in Emergent Surgical Decompression of Orbital Compartment Syndrome. JAMA Otolaryngol Head Neck Surg. 2015 Jun 1;141(6):562-5.</ref> | ||
==Indications<ref name="CJEM">McInnes G, Howes DW. Lateral canthotomy and cantholysis: a simple, vision-saving procedure. CJEM. 2002 Jan;4(1):49-52.</ref>== | ==Indications<ref name="CJEM">McInnes G, Howes DW. Lateral canthotomy and cantholysis: a simple, vision-saving procedure. CJEM. 2002 Jan;4(1):49-52.</ref>== | ||
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==Equipment== | ==Equipment== | ||
*Betadine | *Betadine prep | ||
*Sterile drape or towels | |||
*Lidocaine w/epi | *Lidocaine w/epi | ||
**Syringe with 27-30ga needle | **Syringe with 27-30ga needle | ||
*Normal saline for irrigation | *Normal saline for irrigation | ||
*Straight hemostat | *Straight hemostat or needle driver | ||
* | *Iris or suture scissors | ||
*Forceps | *Forceps | ||
==Procedure== | ==Procedure<ref name="JEM" /><ref name="CJEM" /><ref name="Spec Ops">Ballard SR, Enzenauer RW, O'Donnell T, et al. Emergency lateral canthotomy and cantholysis: a simple procedure to preserve vision from sight threatening orbital hemorrhage. J Spec Oper Med. 2009 Summer;9(3):26-32.</ref>== | ||
'''Consider sedating patient for procedure''' | '''Consider sedating patient for procedure, if time allows''' | ||
* | *Prep and drape the area (Irrigation with normal saline is acceptable prep given emergent nature of procedure) | ||
* | *Inject lidocaine with epi into the lateral canthus directing the needle tip toward the lateral orbital rim (away from the globe) | ||
* | *Apply hemostat to the lateral canthus from the angle of the eye to the orbital rim and clamp shut for ~1 min. (provides relative devascularization as well as a landmark for the canthotomy) | ||
*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== | ==Complications== | ||
Revision as of 04:41, 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
Indications[3]
- 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 prep
- Sterile drape or towels
- Lidocaine w/epi
- Syringe with 27-30ga needle
- Normal saline for irrigation
- Straight hemostat or needle driver
- Iris or suture scissors
- Forceps
Procedure[1][3][4]
Consider sedating patient for procedure, if time allows
- Prep and drape the area (Irrigation with normal saline is acceptable prep given emergent nature of procedure)
- Inject lidocaine with epi into the lateral canthus directing the needle tip toward the lateral orbital rim (away from the globe)
- Apply hemostat to the lateral canthus from the angle of the eye to the orbital rim and clamp shut for ~1 min. (provides relative devascularization as well as a landmark for the canthotomy)
- 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
See Also
References
- ↑ 1.0 1.1 1.2 Rowh AD, Ufberg JW, Chan TC, et al. Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome. J Emerg Med. 2015 Mar;48(3):325-30.
- ↑ Mohammadi F, Rashan A, Psaltis A, et al. Intraocular Pressure Changes in Emergent Surgical Decompression of Orbital Compartment Syndrome. JAMA Otolaryngol Head Neck Surg. 2015 Jun 1;141(6):562-5.
- ↑ 3.0 3.1 McInnes G, Howes DW. Lateral canthotomy and cantholysis: a simple, vision-saving procedure. CJEM. 2002 Jan;4(1):49-52.
- ↑ Ballard SR, Enzenauer RW, O'Donnell T, et al. Emergency lateral canthotomy and cantholysis: a simple procedure to preserve vision from sight threatening orbital hemorrhage. J Spec Oper Med. 2009 Summer;9(3):26-32.