Episode 986: Lateral Canthotomy in Emergency Settings

A 75-year-old motor vehicle crash victim presenting with significant facial trauma and intraocular pressure of 40 mmHg requires an emergency lateral canthotomy to prevent permanent vision loss. This procedure addresses orbital compartment syndrome, a critical condition often caused by retrobulbar hematomas that necessitates intervention within 30 to 60 minutes. Key clinical indicators for the procedure include proptosis, resistance to retropulsion, and an afferent pupillary defect, where the pupil dilates despite direct light exposure due to compromised blood supply or nerve compression. The surgical process involves anesthetizing the area with lidocaine and epinephrine, devascularizing the tissue with hemostats, and incising the lateral canthal tendon to release orbital pressure. Although the procedure results in temporary eyelid laxity, the tendon is easily repaired by ophthalmology later. Performing this rare but essential emergency intervention is vital when immediate specialist consultation is unavailable, as it effectively restores normal ocular pressure and preserves long-term sight.