Lateral canthotomy (part 2) – doing the deed

17 Jan

Ok, so you decided to do a lateral canthotomy (likely due to some combo of orbital trauma and unilateral vision loss, unilateral proptosis, and ocular pressure greater than 40 mm hg, thanks to an expanding retro-orbital hematoma)


How do I actually go about this? (see sources below for more detailed descriptions of the procedure and images)

[description missing]
  • Clean and prep the site. Use sterile technique if time permits.


  • Inject 1 cc of lidocaine with epinepherine into the lateral canthus for control of pain and bleeding. Take care not to inject or injure the globe.


  • Using hemostats, clamp the soft tissue between the lateral canthus and the lateral rim of the orbit (approx 1 cm) for 30-60 seconds to further improve hemostasis and mark the site of incision.


  • With blunt tipped scissors make an incision laterally from the canthus to the rim of the orbit.


  • Using a hemostat or pickups retract the inferior portion of the lid in order to visualize the inferior lateral canthal tendon.


  • With blunt tipped scissors directed inferiorly and posteriorly carefully cut the inferior canthal tendon. If the tendon is correctly severed the lower lid will drop away from the eye. 


  • Recheck ocular pressure. If pressure remains above 40 mm Hg consider repeating the procedure if you suspect the inferior canthal tendon has not been fully released. Additionally the superior lateral canthal tendon may be cut in a similar fashion to the inferior tendion if ocular pressure remains above 40 mm Hg after inferior cantholysis.
There you go.  Add it to the toolbox.
Submitted by Lee Cunningham.

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