Morning Report: Lateral Orbital Canthotomy

Thanks to Dr. Wang for today’s Morning Report!

Lateral Orbital Canthotomy

Indications:

• Retrobulbar hemorrhage
• Increase IOP (IOP >40mm Hg)
• Proptosis

Contraindications:

• Globe rupture
  • Hyphema
  • Tear-drop-shaped pupil
  • Peaked or irregularly shaped pupil

Procedure:

• Positioning: patient in the supine position. Possibly restrained or undergo conscious sedation
• Local anesthesia (lidocaine 1-2% with epinephrine) is injected into the lateral canthus. Direct need tip toward the lateral orbital rim and begin injecting when the needle hits bone.
• Irrigate the affected eye of debris with normal saline
• Use the hemostat to clamp the skin at the lateral corner of the patient’s eye for 1-2 mins. Helps to achieve hemostasis and mark the location where the incision is to be made.

• Use forceps to pick up the skin around the lateral orbit
• Use scissors to make a 1-2 cm incision beginning at the lateral corner of the eye and extending laterally outward
• Retract the inferior lid downward to visualize the lateral canthus tendon
• Direct scissors along lateral orbital rim
• If IOP remains > 40mm Hg, cut superior portion of the lateral tendon by dissecting superiorly before cutting it
• Successful procedure is marked by improved visual acuity and decrease of IOP to below 40mm Hg.

References:

http://emedicine.medscape.com/article/82812-overview

http://www.emcurious.com/blog-1/2014/9/25/the-lateral-canthotomy

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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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