From the Research
The One-Snip Method, a paracanthal "one-snip" incision, is a rapid and effective emergency procedure for treating orbital compartment syndrome, and it should be performed immediately when the condition is suspected, as it offers a more manageable alternative treatment that can produce a satisfactory intraocular pressure reduction. This procedure is a sight-saving intervention that requires prompt action to avoid ischemic damage to the optic nerve and retina. The indications for the One-Snip Method include decreased visual acuity, afferent pupillary defect, proptosis, restricted extraocular movements, and increased intraocular pressure (typically >40 mmHg) 1.
The procedure involves making a single incision at the lateral canthus, which can be done using straight scissors to release the tension in the orbital compartment, allowing for immediate reduction in intraocular pressure and restoration of blood flow to the optic nerve. Local anesthesia with 1-2% lidocaine with epinephrine should be infiltrated before the procedure to minimize pain and discomfort. After the procedure, immediate assessment of intraocular pressure should be performed to ensure adequate decompression, and if pressure remains elevated, additional interventions such as superior cantholysis may be necessary 1.
Some studies have compared the efficacy of different procedures for orbital compartment syndrome, including lateral canthotomy and cantholysis, and inferior orbital septum release 2, 3, 4. However, the most recent and highest quality study suggests that the One-Snip Method is a viable and effective alternative to these procedures 1.
It is essential to note that prompt decompression is crucial for visual recovery in orbital compartment syndrome, and the One-Snip Method offers a rapid and effective way to achieve this goal 1. Following the procedure, the patient should receive appropriate antibiotics, analgesics, and urgent ophthalmology consultation for definitive management of the underlying cause. The One-Snip Method is a valuable addition to the emergency physician's toolkit for managing orbital compartment syndrome, and it can be performed at the bedside with simple instruments 5.
Key points to consider when performing the One-Snip Method include:
- Prompt intervention is crucial to avoid ischemic damage to the optic nerve and retina
- The procedure should be performed immediately when orbital compartment syndrome is suspected
- Local anesthesia should be used to minimize pain and discomfort
- Immediate assessment of intraocular pressure should be performed after the procedure to ensure adequate decompression
- Additional interventions such as superior cantholysis may be necessary if pressure remains elevated
- The patient should receive appropriate antibiotics, analgesics, and urgent ophthalmology consultation for definitive management of the underlying cause.