Name of the Procedure:

Canthotomy (lateral canthotomy)

Summary

A canthotomy is a surgical procedure where an incision is made at the outer corner of the eye to relieve pressure within the orbit, typically performed on an emergency basis to prevent vision loss.

Purpose

The procedure addresses acute orbital compartment syndrome, which can result from trauma or infection. The goal is to alleviate elevated pressure within the orbit to preserve vision and prevent damage to the optic nerve and other ocular structures.

Indications

• Sudden onset of decreased vision
• Proptosis (bulging of the eye)
• Elevated intraocular pressure
• Orbital hemorrhage or infection

Preparation

• No specific pre-procedure fasting or medication adjustments are generally required.
• A thorough eye examination and imaging (e.g., CT scan) to confirm the diagnosis.
• In an emergency scenario, the procedure may be initiated without extensive preparation.

Procedure Description

1. The patient is positioned lying down.
2. Local anesthesia is administered to numb the area around the eye.
3. Using a sterile technique, the surgeon makes a small incision at the outer canthus (corner) of the affected eye.
4. The lateral canthal tendon is incised to allow the orbital tissues to expand and relieve pressure.
5. Hemostasis is achieved, and the wound may be left to heal naturally or closed with sutures if necessary.

Duration

The procedure typically takes around 10-20 minutes.

Setting

Performed in an emergency department, operating room, or other clinical setting equipped for minor surgical procedures.

Personnel

• Emergency physician or ophthalmologist
• Assisting nurse or technician

Risks and Complications

• Infection
• Bleeding
• Scarring
• Injury to surrounding structures, including the optic nerve
• Incomplete relief of orbital pressure

Benefits

• Rapid relief of orbital pressure
• Prevention of permanent vision loss
• Minimal long-term complications if performed promptly and correctly

Recovery

• Post-procedure care includes ice packs to reduce swelling and antibiotic ointment to prevent infection.
• Pain is usually managed with over-the-counter pain medications.
• Follow-up appointments to monitor healing and ensure that intraocular pressure remains normal.
• Recovery typically occurs within 1-2 weeks; functionality and appearance improve as the healing progresses.

Alternatives

• Emergency decompressive craniotomy in severe cases with additional intracranial pressure.
• Observation and medical management in less severe cases.
• Pros: Non-invasive alternatives may have fewer immediate risks.
• Cons: Lack of prompt surgical intervention can lead to irreversible vision loss.

Patient Experience

• Mild discomfort or pain during the procedure due to local anesthesia.
• Sensation of pressure relief in the affected eye soon after the incision.
• Postoperative pain and swelling, managed with medications and cold compresses.
• Periodic follow-up evaluations to ensure effective pressure relief and healing.