Canthotomy: Difference between revisions

Revision as of 03:33, 3 July 2015

Indications

Acute Orbital Compartment Syndrome (OCS)

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 lido 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

References

Authors:

@@ Line 1: / Line 1: @@
 ==Indications==
-Indicated in pt with acute orbital compartment syndrome
+*Acute Orbital Compartment Syndrome (OCS)
-===Absolute indications<ref>Rowh, AD, et al. Lateral Canthotomy and Cantholysis: Emergency Management of Orbital Compartment Syndrome. Journal of Emergency Medicine. 2014; S0736-4679(14)01222-0. http://dx.doi.org/10.1016/j.jemermed.2014.11.002</ref>===
-# acute loss of visual acuity
-# increased intraocular pressure (>40 mm Hg)
-# severe proptosis
-# diffuse subconjunctival hemorrhage
-# periorbital edema
-# retrobulbar hemorrhage with afferent pupillary defect or restriction of eye movemeents
-===Relative indications===
-# afferent pupillary defect
-# ophthalmoplegia
-# cherry red macula
-# optic nerve pallor
-# severe eye pain
-# periorbital crepitus/edema
 ==Contraindications ==
-globe rupture
+*Globe Rupture
 ==Equipment==
-# Lidocaine w/epi
+*Betadine/Iodine prep
-# sterile gloves, face shield, gown
+*Lidocaine w/epi
-# sterile field
+**Syringe with 27-30ga needle
-# syringe with 25 gauge needle
+*Sterile gloves, face shield, gown
-# normal saline for irrigation
+*Sterile drape or towels
-# straight hemostat
+*Normal saline for irrigation
-# sterile iris or suture scissors
+*Straight hemostat
-# forceps
+*Sterile iris or suture scissors
-# betadine/iodine prep
+*Forceps
 ==Procedure==
-# consider sedating patient for procedure
+consider sedating patient for procedure
-# prep and drape the area
+*prep and drape the area
-# inject 1cc of lido with epi into the lateral canthus directing the needle tip toward the lateral orbital rim
+*inject 1cc of lido with epi into the lateral canthus directing the needle tip toward the lateral orbital rim
-# irrigate eye to eliminate debris
+*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)
+*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
+*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
+*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)
+*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
+*recheck IOP, if still elevated cut the superior crux of the tendon
 ==Complications==
-# iatrogenic globe/tendon/lacrimal duct injury
+*iatrogenic globe/tendon/lacrimal duct injury
-# loss of adequate lower lid suspension
+*loss of adequate lower lid suspension
-# bleeding
+*bleeding
-# infection
+*infection
-# fibrosis
+*fibrosis
-# vision loss
+*vision loss
 ==See Also==
 *[[Orbital Hematoma]]
-==Sources==
+==References==
 <references/>
 [[Category:Procedures]]
 [[Category:Ophtho]]