Lateral Canthotomy / Cantholysis for Retrobulbar Hemorrhage- Procedure Instructions



Quickly throw a few cc's of lido with epinephrine into the lateral canthus, and then squeeze it with a hemostat to reduce bleeding.  Then snip through the canthus toward the orbital rim.  Pull down and locate the inferior crus of the lateral canthal ligament (this is the cantholysis of the procedure, visualized with the cadaver image below).  Recheck your IOP at this time--if it's still elevated you can snip the superior crus as well.



If done properly the lower lid should fall away from the lid margin.  Often patients have dramatic improvement in vision but it's possible that this may take longer to return (assuming you've cut in time to save the structures).  Just like other facial wounds they tend to heal well without any significant scarring.  Regardless, now you'll really need the specialist for a definitive closure.



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