Canthotomy
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