OPHTHALMOLOGY
LATERAL CANTHOTOMY AND CANTHOLYSIS
Apparently ACEM needs the “and Cantholysis” bit to pay marks
PromptIndications for lateral canthotomy in trauma
ResponseAcute vision loss
RAPD
Proptosis
IOP >40 mm.Hg
RAPD
Proptosis
IOP >40 mm.Hg
PromptContraindications for lateral canthotomy
ResponseSuspected globe rupture (relative contraindication)
Subconjunctival haemorrhage is a subtle sign for globe rupture
Subconjunctival haemorrhage is a subtle sign for globe rupture
PromptDescribe the steps in performing a lateral canthotomy
ResponseConsent - Urgent and sight saving - if intoxicated can do under duty of care.
sterile prep, +/- procedural sedation (Especially if agitated)
2mL 1% lignocaine to lateral canthus
Crush lateral canthus with artery clamp to reduce bleeding 60 sec
Cut along lateral canthus 1cm toward orbital rim (Scissors)
Retract lower lid down, identify and “strum” inferior crus of lateral canthus ligament - incise inferior crus with scissors (Some say cut superior first)
Recheck pressures/movement/RAPD, if not improved divide superior canthus
sterile prep, +/- procedural sedation (Especially if agitated)
2mL 1% lignocaine to lateral canthus
Crush lateral canthus with artery clamp to reduce bleeding 60 sec
Cut along lateral canthus 1cm toward orbital rim (Scissors)
Retract lower lid down, identify and “strum” inferior crus of lateral canthus ligament - incise inferior crus with scissors (Some say cut superior first)
Recheck pressures/movement/RAPD, if not improved divide superior canthus