Retrobulbar Hematoma
Lateral canthotomy: Be a Nike ninja and just do it! - Anton Helman
image by: Critical-Care Professionals International, PLLC
HWN Suggests
EM Quick Hits: Lateral Canthotomy...
Lateral canthotomy – cantholysis
- Time is eye; a lateral canthotomy is indicated for trauma patients with orbital compartment syndrome within 60-120 minutes of onset of ischemic features (decreased visual acuity and RAPD) as a temporizing measure to definitive surgical evacuation of the retrobulbar hematoma.
- Clinical clues to orbital compartment syndrome include mechanical consequences (proptosis from the retrobulbar hematoma – most easily seen from the head of the bed with the patient lying supine – IOP>40mmHg and impaired extraocular movements), and ischemic consequences (decreased visual acuity, RAPD and a blown pupil)
- Do not wait…
Resources
Lateral Canthotomy – procedure guide
A 21 year old man was minding his own business on a street corner, when out of nowhere two dudes just jumped him. His primary injury appears to be to his right eye. He is complaining of a lot of eye pain and blurred vision. On exam, you note proptosis and an afferent pupillary defect. The opthamologist is covering at another hospital and is at least an hour away, but suggests you go ahead with the lateral canthotomy…
Orbital Compartment Syndrome: Pearls and Pitfalls for the ED Physician
Have a high level of suspicion for OCS in any patient with facial trauma or recent orbital surgery. Vision loss may be a late sign, so perform a thorough eye exam and measure the IOP early. IOP greater than 30mmHg necessitates a call to the ophthalmologist, while IOP greater than 40mmHg should be treated immediately with LCIC.
An Ocular Emergency
Retrobulbar hematoma, which can also be conceptualized as “orbital compartment syndrome,” is a vision-threatening condition and ophthalmologic emergency. Retrobulbar hemorrhage has been described after trauma as well as after facial surgery, and this presentation may be delayed up to days after injury.
Bashed, Blind and Bulging
Therapy depends on whether there is compressive optic neuropathy or severely raised IOP: Evidence of optic neuropathy or severely raised IOP (>40 mmHg): lateral canthotomy and cantholysis should be performed immediately (ideally by an ophthalmologist); use procedural sedation in the ED if it does not cause a delay. No evidence of optic neuropathy but IOP is raised (e.g. >30 mmHg): treat with agents used to lower IOP (e.g. topical timolol, acetazolamide, mannitol; see acute glaucoma).
Blunt Ocular Trauma Live from The EM Cases Course
Time is eye. A Lateral canthotomy is indicated for patients with OCS within 60-120 minutes of onset of ischemic features as a temporizing measure to definitive surgical evacuation of the retrobulbar hematoma. Similar to performing a cricothyrotomy, the biggest pitfall when it comes to performing a lateral canthotomy is the decision to do it.
EM Quick Hits: Lateral Canthotomy...
Time is eye; a lateral canthotomy is indicated for trauma patients with orbital compartment syndrome within 60-120 minutes of onset of ischemic features (decreased visual acuity and RAPD) as a temporizing measure to definitive surgical evacuation of the retrobulbar hematoma..
EyeWiki
In patients with vision loss, proptosis, extraocular movement deficiencies, or any sign of elevated IOP, lateral canthotomy with cantholysis has been shown to be an effective first line treatment.
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