see also: [[Facial trauma radiology]], [[eye trauma]] → [[eye trauma#retrobulbar haematoma]] see [emergency procedures video lateral canthotomy](https://app.emergencyprocedures.org/) [Robert Hedges orbital compartment syndrome](x-devonthink-item://31ACDC98-D2CC-48C5-BE69-E9B37E53FA8C?page=1506&start=3192&length=7&search=Orbital) #opthal # Orbital compartment syndrome - acute [[Facial trauma radiology| facial trauma]] can produce retrobulbar haemorrhage with enough pressure to compromise **ophthalmic artery** and cause ==orbital compartment syndrome== - post-traumatic glaucoma can also occur: retrobulbar haematoma → glove against eyelids → IOP rises → optic nerve, vascular supply, central retinal artery compressed → *ischaema and vision loss* ![[Pasted image 20230829231202.png| note extensive chemosis (swelling around the conjunctiva), dilated pupil, propotosis, subconjunctival haemorrhage, and periorbital bruising]] ![[Pasted image 20241108154552.png|Orbital anatomy on CT]] # indications - suspected orbital compartment syndrome (pain, proptosis, raised **IOP > 40 mmHg**) (eg from [[eye trauma#retrobulbar haematoma]]) AND - evidence of retinal dysfunction (visual loss or [[Relative afferent pupillary defect]]) - elevated retrobulbar pressure - decreased visual acuity - afferent pupil defect - IOP elevated - +/- ophthalmoplegia # Contraindications - globe rupture # Timing 2 hours from time of injury # Complications - failure (incomplete cantholysis) - globe injury - lacriminal artery, gland, or muscle injury - bleeding - infection # Procedure - Amethocaine 0.5-1% drops in eye - anethatise lateral canthus with lignocaine + adreanline - irrigate eye with sale clear debris - crimp lateral canthus with small haemostat to minimise bleeding - incise canthus with iris scissors - retract inferior eyelid with forceps and identify ==inferior crus of lateral canthal tendon== - incise inferior crus of lateral canthal tendone inferio-posteriorally (cantholysis) - re-assess eye for visual acuity, resolution of RAPD, IOP <40 - if no improvement, confirm cantholysis (lower eyelid freely mobile, no tendon palpable with forceps), then proceed to divide the ==superior crus of the lateral canthal tendon== ![[Pasted image 20241108154236.png]] # Post procedure - apply moist gauze dressing - urgent ophthal review - re-assess visual acuity and [[Relative afferent pupillary defect|RAPD]] Q30 min # Related Questions ## Lateral canthotomy - [x] 8Q: [Head Injury](x-devonthink-item://4134DDB3-6E12-474A-9F6F-64135C0C6048?page=14) -- [Answer](x-devonthink-item://AC92B5F1-8EE6-461A-B03E-F70AE7DC1275?page=14) -- [prop](x-devonthink-item://68EA6F60-334D-4A94-8327-78286C5F1AED?page=4) - [x] 9Q: [Eye trauma](x-devonthink-item://85167CB5-A7B5-4BF3-9BC7-AC46D5538A42?page=13) -- [Answer](x-devonthink-item://5B03E66C-E043-4EB7-A5F6-7389CB927BD7?page=18) -- [prop](x-devonthink-item://D0A460D5-938B-4002-A684-EFD9189B08C1?page=13)