Canthotomy: Difference between revisions
(Created page with "==Indications== Indicated in pt with acute orbital compartment syndromeAbsolute indications: - acute loss of visual acuity - increased intraocular pressure (>40 mm Hg) - se...") |
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==Equipment== | ==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== | ==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== | ==Complications== | ||
# iatrogenic globe/tendon/lacrimal duct injury | |||
# loss of adequate lower lid suspension | |||
# bleeding | |||
# infection | |||
# fibrosis | |||
# vision loss | |||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Ophtho]] |
Revision as of 06:10, 9 June 2011
Indications
Indicated in pt with acute orbital compartment syndromeAbsolute 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