Canthotomy: Difference between revisions
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==Background== | |||
*Causes of acute orbital compartment syndrome (OCS)<ref name="JEM">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.</ref> | |||
**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<ref name="JEM" /> - do not delay procedure | |||
==Indications== | ==Indications== | ||
*Acute Orbital Compartment Syndrome (OCS) | *Acute Orbital Compartment Syndrome (OCS) | ||
==Contraindications == | ==Contraindications== | ||
*Globe Rupture | *Globe Rupture | ||
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==Procedure== | ==Procedure== | ||
'''Consider sedating patient for procedure''' | |||
*prep and drape the area | *prep and drape the area | ||
*inject 1cc of | *inject 1cc of lidocaine 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) | ||
Revision as of 04:02, 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
- 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 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