Indications
- Orbital compartment synd.
- pain, proptosis, IOP >40mmHg
- plus
- Visual loss or RAPD
- Clinical Dx (not radiological)
Kit
- 1% amethiocaine drops
- 5ml lignocaine 2% with adrenaline
- 5ml syringe with 25g needle
- Haemostat (straight of possible)
- Tissue forceps x 2
- Suture scissors
RAPD
Procedure
Video (scroll tabs left of page).
- 2 drops of amethocaine to eye
- Inject 2ml of lignocaine (w adrenaline) into the lateral canthus directing needle tip laterally, away from the globe
- Clamp lateral canthus (haemostat) to the orbital rim x1 min., then remove
- Incise 1cm with scissors from lateral corner of the eye out to the orbital rim
- Retract the inferior eyelid with forceps and identify the inferior crus of the lateral canthal tendon
- Incise inferior crus of the lateral canthal tendon infero-posteriorally with scissors
- Reassess eye for improvement in visual acuity, resolution of RAPD, with IOP <40mmHg
- If no improvement, confirm cantholysis (lower eyelid freely mobile, no tendon palpable with forceps), divide the superior crus of the lateral canthal tendon
Post-op
- Analgesia
- Moist gauze dressing
- Recheck VA and IOP
- Urgent ophthalmology review
- Documentation