From the Research
Lateral canthotomy is primarily indicated for the emergency treatment of orbital compartment syndrome, which is a sight-threatening condition characterized by increased intraocular pressure that can lead to permanent vision loss if not promptly addressed. The procedure should be performed when there are clinical signs of orbital compartment syndrome, including decreased visual acuity, afferent pupillary defect, increased intraocular pressure (typically >40 mmHg), proptosis, restricted extraocular movements, and retinal venous engorgement or cherry-red spot on fundoscopic examination 1. Common causes necessitating lateral canthotomy include retrobulbar hemorrhage following facial trauma, orbital surgery, or retrobulbar injections; severe orbital cellulitis; or significant orbital edema from any cause.
Some key points to consider when performing a lateral canthotomy include:
- The procedure involves cutting the lateral canthal tendon to decompress the orbit and reduce intraocular pressure 2.
- It should be performed immediately when orbital compartment syndrome is suspected, as irreversible vision loss can occur within 60-120 minutes of onset.
- The procedure is relatively simple and can be performed at the bedside using local anesthesia, making it a critical skill for emergency physicians, ophthalmologists, and other healthcare providers who may encounter this urgent condition.
- Success rates of lateral canthotomy and cantholysis for treatment of orbital compartment syndrome are comparable amongst emergency medicine and ophthalmology providers, with a success rate of 68% vs 79.2%, respectively 1.
In terms of the evidence, the most recent and highest quality study 1 supports the use of lateral canthotomy and cantholysis for the treatment of orbital compartment syndrome, with a success rate of 68% amongst emergency medicine providers and 79.2% amongst ophthalmology providers. This study also highlights the importance of prompt intervention in orbital compartment syndrome to prevent irreversible vision loss.
Overall, lateral canthotomy is a critical procedure for the emergency treatment of orbital compartment syndrome, and should be performed promptly when clinical signs of the condition are present.