User:Mr. Ibrahem/Lateral canthotomy

Lateral canthotomy is an emergency procedure used to treat acute orbital compartment syndrome (OCS). This may present with vision problems, increased intraocular pressure (IOP), decreased ability to move the eye, and dilation of the opposite pupil when a light is swung to shine in the affected eye. Ideally it should be performed within two hours. The procedure dose not take long to perform.

The most common cause of acute OCS is an injury resulting in a bleeding behind the globe. Other causes include spontaneous bleeding, recent eye surgery, and orbital infections. Contraindications to the procedure include a ruptured globe.

The procedure involves freezing the skin lateral to the eye with lidocaine with epinephrine. The lateral corner of the eye is then briefly crushed with a hemostat. A 1 to 2 cm cut is then made through this tissue with blunt tipped scissors. The lower eyelid is then pulled away to expose the lateral canthal tendon. The lower part of this tendon is than cut with the scissors. If this is not sufficient the upper part may also be cut.

Signs of success include a mobile lower eyelid, decreased IOP, and improved vision. After the procedure the cut is left open and covered with a sterile dressing. The head of the bed should be placed at 45 degrees, if possible. Closure may occur by an ophthalmologist after a few days.