Canthotomy: Difference between revisions
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==Indications== | ==Indications== | ||
Indicated in pt with acute orbital compartment syndrome | |||
===Absolute indications=== | |||
# acute loss of visual acuity | |||
# increased intraocular pressure (>40 mm Hg) | |||
# severe proptosis | |||
# diffuse subconjunctival hemorrhage | |||
# periorbital edema | |||
===Relative indications=== | |||
# afferent pupillary defect | |||
# ophthalmoplegia | |||
# cherry red macula | |||
# optic nerve pallor | |||
# severe eye pain | |||
# periorbital crepitus/edema | |||
Relative indications | |||
==Contraindications == | ==Contraindications == | ||
globe rupture | globe rupture | ||
==Equipment== | ==Equipment== |
Revision as of 06:22, 9 June 2011
Indications
Indicated in pt with acute orbital compartment syndrome
Absolute indications
- acute loss of visual acuity
- increased intraocular pressure (>40 mm Hg)
- severe proptosis
- diffuse subconjunctival hemorrhage
- periorbital edema
Relative indications
- afferent pupillary defect
- ophthalmoplegia
- cherry red macula
- optic nerve pallor
- severe eye pain
- periorbital crepitus/edema
Contraindications
globe rupture
Equipment
- Lidocaine w/epi
- sterile gloves, face shield, gown
- sterile field
- syringe with 25 gauge needle
- normal saline for irrigation
- straight hemostat
- sterile iris or suture scissors
- forceps
- betadine/iodine prep
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