From the Research
Lateral canthotomy should be performed immediately in cases of suspected orbital compartment syndrome, particularly when there is acute onset of proptosis, decreased visual acuity, and increased intraocular pressure (>40 mmHg), as evidenced by the most recent study in 2023 1. The procedure is time-critical and should be done within minutes to hours of symptom onset to prevent permanent vision loss. Key clinical signs indicating the need for lateral canthotomy include:
- A tense, proptotic eye
- Restricted eye movements
- Pain with eye movement
- An afferent pupillary defect The procedure involves making an incision at the lateral canthus to relieve pressure within the orbit. It's typically performed in emergency settings following trauma, retrobulbar hemorrhage, or severe orbital cellulitis. While it's a relatively simple procedure, it should only be done by trained medical professionals, as highlighted in a study from 2019 2. The urgency of the situation often outweighs potential risks, as failure to act quickly can result in irreversible blindness, as noted in a study from 2014 3. Post-procedure, patients require close monitoring and may need further ophthalmological intervention. The success rate of lateral canthotomy is comparable amongst emergency medicine and ophthalmology providers, with a study from 2023 1 showing success rates of 68% and 79.2%, respectively. Improved training of physicians on the lateral canthotomy or other simpler procedures, such as the vertical lid split, could improve outcomes in orbital compartment syndrome, as suggested by the 2023 study 1.