From the Research
Lateral canthotomy is a critical emergency procedure that should be performed promptly to relieve orbital compartment syndrome and preserve vision, as evidenced by the most recent study 1. To perform a lateral canthotomy, first administer local anesthesia (1-2% lidocaine with epinephrine) at the lateral canthus. Using straight scissors, make a horizontal incision approximately 1 cm long from the lateral canthus toward the ear. After the canthotomy, perform a cantholysis by cutting the inferior crus of the lateral canthal tendon to fully release orbital pressure. Success is indicated by immediate tissue prolapse and improved patient comfort. This procedure is time-sensitive and should be performed within 90-120 minutes of symptom onset to prevent permanent vision loss. The most common indication is retrobulbar hemorrhage following facial trauma or surgery, but it may also be needed for severe orbital cellulitis or inflammation. Key considerations for the procedure include:
- Administering local anesthesia to minimize pain and discomfort
- Making a precise incision to avoid damaging surrounding tissue
- Performing cantholysis to fully release orbital pressure
- Monitoring for immediate tissue prolapse and improved patient comfort as indicators of success After the procedure, patients require ophthalmology follow-up for definitive management of the underlying cause and eventual repair of the canthal tendon, as highlighted in studies such as 2 and 3. It is essential to prioritize the patient's vision and overall outcome, and to consider the potential benefits and risks of the procedure, as discussed in 4 and 5. By following this approach, healthcare providers can ensure the best possible outcome for patients undergoing lateral canthotomy.