Canthotomy

Indications

Indicated in pt with acute orbital compartment syndrome

Absolute indications

1. acute loss of visual acuity
2. increased intraocular pressure (>40 mm Hg)
3. severe proptosis
4. diffuse subconjunctival hemorrhage
5. periorbital edema

Relative indications

1. afferent pupillary defect
2. ophthalmoplegia
3. cherry red macula
4. optic nerve pallor
5. severe eye pain
6. periorbital crepitus/edema

Contraindications

globe rupture

Equipment

1. Lidocaine w/epi
2. sterile gloves, face shield, gown
3. sterile field
4. syringe with 25 gauge needle
5. normal saline for irrigation
6. straight hemostat
7. sterile iris or suture scissors
8. forceps
9. betadine/iodine prep

Procedure

1. consider sedating patient for procedure
2. prep and drape the area
3. inject 1cc of lido with epi into the lateral canthus directing the needle tip toward the lateral orbital rim
4. irrigate eye to eliminate debris
5. 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)
6. 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
7. retract the inferior lid and dissect bluntly until you palpate/visualize the lateral canthus tendon
8. cut the inferior crux of the lateral canthus tendon (point scissors infero-posteriorally toward the lateral orbital rim avoiding the globe)
9. recheck IOP, if still elevated cut the superior crux of the tendon

Complications

1. iatrogenic globe/tendon/lacrimal duct injury
2. loss of adequate lower lid suspension
3. bleeding
4. infection
5. fibrosis
6. vision loss