Lateral Canthotomy/Cantholysis

June 5, 2023/

As ophthalmologists, it is important to be prepared to perform an emergent lateral canthotomy and cantholysis in cases of orbital compartment syndrome, a rare but serious condition that can occur after trauma or surgery. In this blog post, we will discuss the steps involved in performing an emergent lateral canthotomy and cantholysis.

Step 1: Recognize the signs of orbital compartment syndrome

The first step in performing an emergent lateral canthotomy and cantholysis is to recognize the signs of orbital compartment syndrome, which include:

  • Proptosis (bulging of the eye)
  • Decreased visual acuity
  • Pain or discomfort
  • Limited eye movement
  • Elevated intraocular pressure

Step 2: Obtain informed consent

Once orbital compartment syndrome has been diagnosed, informed consent should be obtained from the patient or their guardian if possible. The procedure should be explained, including the risks and benefits.

Step 3: Anesthetize the area

Local anesthesia should be administered to the area around the lateral canthus using a topical or injectable anesthetic agent.

Step 4: Secure the lateral canthus

A clamp with a hemostat should be used to secure the lateral canthus just lateral to the lateral canthal tendon. The hemostat is used to gently grasp the tissue.

Step 5: Make the incision

A pair of blunt-tipped scissors is used to make an incision through the lateral canthal tendon. The scissors are inserted along the same axis as the lateral canthus and then turned 90 degrees to make the incision.

Step 6: Grasp the free end of the lateral canthal tendon

Toothed forceps are used to grasp the free end of the lateral canthal tendon and pull it away from the eye.

Step 7: Cut the lateral canthal tendon

Using scissors or a scalpel, the lateral canthal tendon is cut completely, allowing the lateral canthus to be moved laterally and relieving pressure in the orbital compartment.

Step 8: Reassess the patient

After the lateral canthotomy and cantholysis have been performed, the patient should be reassessed to determine the effectiveness of the procedure. Additional treatment, such as a surgical decompression, may be necessary.

In conclusion, performing an emergent lateral canthotomy and cantholysis requires a rapid and systematic approach to relieve pressure in the orbital compartment. By recognizing the signs of orbital compartment syndrome, obtaining informed consent, and following the steps outlined above, ophthalmologists can perform this life-saving procedure when necessary.