In this episode we interview the ophthalmologist Dr. Shad Saunders. We discuss orbital compartment syndrome and the management of the condition in the Emergency Department–specifically performing the lateral canthotomy.
Orbital compartment syndrome is when the contents of the orbit are under pressure, typically due to a space occupying lesion such as hematoma. Since there is no room for expansion within the bony orbit, this can lead to elevated pressures that can cut off blood supply to the optic nerve, muscles, and eye. The symptoms of orbital compartment syndrome can include:
- Periocular trauma
- Proptosis
- Decreased extra-ocular movements
- Double vision
- Decreased vision
- Subconjunctival hemorrhage
- Chemosis
- Increased intraocular pressure
- Pupil abnormalities
- Afferent pupillary defect
- Vision changes or loss
Orbital compartment syndrome is a clinical diagnosis in the Emergency Department and should be treated before further work-up is completed. Since this is a time sensitive condition and can lead to vision loss, a lateral canthotomy should be performed as soon as possible. You should not wait for imaging confirmation.
The lateral canthotomy is performed in the following way:
- Clean the skin with betadine
- Anesthetize the lateral canthal region with lidocaine with epinephrine
- Make a 1 cm incision at the lateral canthus with a 15 blade scalpel or scissors
- Using toothed forceps, grasp the lower lid and apply anterior traction to the lid
- Locate the canthal tendon by “strumming” them with scissors
- Once the canthal tendon fibers are located, cut them with the scissors
- Continue strumming and cutting until you have completely released the inferior canthal tendon
- Recheck pressure in the eye. If the pressure is still elevated, perform the same procedure on the superior canthal tendon
You can view our video of the procedure performed by Dr. Saunders himself on our YouTube channel!
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Download the episode here: Episode 19: Lateral Canthotomy
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