Lateral Canthotomy

[The White Coat Investor]

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I had a patient who needed a lateral canthotomy STAT the other night. First time for me (even seeing it). Really, no big deal though. Dropped the pressure immediately from 70 to 40 and vision started improving almost immediately.

 

[txterp98]

Nice! I did one as a resident on a guy who fell off a ladder and had unilateral proptosis and near-blindness. Definitely a cool yet simple procedure!

Can you give any more info on your patient? Did you cut immediately based on the clinical presentation like the books recommend or was it a case where you could get a CT and stat read expeditiously enough that you waited for confirmation?

 

[Fah-Q]

Did you cut immediately based on the clinical presentation like the books recommend or was it a case where you could get a CT and stat read expeditiously enough that you waited for confirmation?

I'm confused. How would a CT help? Orbital compartment syndrome is a clinical diagnosis.

 

[txterp98]

I certainly agree that orbital compartment syndrome is a clinical diagnosis.

Sometimes, though, traumatic proptosis with vision loss can be found in the setting of open globe/commotio retinae/traumatic optic neuropathy....any of which can be associated with significant edema as opposed to hemorrhage.

If I'm not mistaken (but I certainly could be mistaken, so I am willing to learn), I don't think a lateral canthotomy/inferior cantholysis is indicated in those conditions. Then again, like you point out, orbital compartment syndrome is a clinical diagnosis and perhaps expression of the edematous fluid is indicated?

Thanks for opening up the discussion. I'm curious about how many others have gotten to do this procedure.

 

[name?]

I certainly agree that orbital compartment syndrome is a clinical diagnosis.

Sometimes, though, traumatic proptosis with vision loss can be found in the setting of open globe/commotio retinae/traumatic optic neuropathy....any of which can be associated with significant edema as opposed to hemorrhage.

If I'm not mistaken (but I certainly could be mistaken, so I am willing to learn), I don't think a lateral canthotomy/inferior cantholysis is indicated in those conditions. Then again, like you point out, orbital compartment syndrome is a clinical diagnosis and perhaps expression of the edematous fluid is indicated?

Thanks for opening up the discussion. I'm curious about how many others have gotten to do this procedure.

I did one as a resident--golf club to the orbit--> 8 ball pupil and marked proptosis. It turns out not to have mattered because of the associated injuries... he lost his vision anyway. It was the procedure I wanted to do the least(besides perimortem c-section), but wasn't as bad as I thought it would be. I don't know who golfs in the ghetto, but it worked like a charm as a bludgeon. We actually scanned him first because he was drunk and we wanted to r/o ICH before saving the eye.

 

[Interpolfanclub]

Done one of these, been involved with several during residency. My case was typical assault, very altered, CHI, tubed. We suspected it before the CT, but CT showed obvious retrobulbar hematoma. Elevated pressures before canthotomy, decreased afterwards. Not terribly difficult procedure once you get over the fact you're cutting ligaments next to someone's eye. Saw the guy a few days later and he had his vision back. Very rewarding procedure.

 

[WilcoWorld]

I've only cantholyzed anesthetized pigs and cadavers. What have those of you who have done this on people use for analgesia?

 

[kungfufishing]

I've only cantholyzed anesthetized pigs and cadavers. What have those of you who have done this on people use for analgesia?

Mine was mostly drunkocaine, in that state most commonly displayed by the guy who forgets you are sewing him up, and some local.

 

[Fah-Q]

I certainly agree that orbital compartment syndrome is a clinical diagnosis.

Sometimes, though, traumatic proptosis with vision loss can be found in the setting of open globe/commotio retinae/traumatic optic neuropathy....any of which can be associated with significant edema as opposed to hemorrhage.

If I'm not mistaken (but I certainly could be mistaken, so I am willing to learn), I don't think a lateral canthotomy/inferior cantholysis is indicated in those conditions. Then again, like you point out, orbital compartment syndrome is a clinical diagnosis and perhaps expression of the edematous fluid is indicated?

Thanks for opening up the discussion. I'm curious about how many others have gotten to do this procedure.

You're right, a canthotomy and cantholysis is only indicated in compartment syndrome. OTOH, it won't cause any harm and you might just save an eye. It's kinda like a surgical airway...if you think about it, you should be doing it...nothing to lose and everything to gain.