Morning Report: 8/30/2013

Here’s Dr. Youn with today’s Morning Report!

Lateral Canthotomy/Cantholysis

Emergent concern: retinal ischemia, optic nerve compression

Indications: Acute orbital compartment syndrome – usually 2/2 traumatic retrobulbar hemorrhage

Decreased visual acuity

IOP > 40 mmHg (normal range: 10-20)

Proptosis

APD

Contraindication: Globe rupture (teardrop pupil, positive Seidel test, enophthalmos, visible globe laceration, visible FB in eye)

Procedure:

1. Stat ophthalmology consult
2. Irrigate area with saline or sterile water – avoid betadine in eye
3. Local anesthetic to lateral canthus – 1cc of 1-2% lidocaine with epi
4. Apply hemostat to lateral canthus for 1-2 min to crush structures and decrease bleeding
5. Cut laterally from lateral canthus to orbital rim – approx. 1cm
6. Use forceps to retract lower lid down infero-laterally to expose inferior crus of lateral canthal ligament
7. Cut inferior crus full thickness to orbital rim – lower eyelid should hang loosely
8. Recheck IOP
9. If still elevated, consider releasing superior crus of lateral canthal ligament.
10. Discuss further medical management with ophtho if IOP still elevated – acetazolamide, topical beta blockers, mannitol, elevate HOB
11. Definitive – ophthalmologic decompression

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• Bio
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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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