Lateral Canthotomy - Procedure Instructions
1) Identify the lateral canthus.
Cleanse the area with antiseptic and anesthetize with 1% lidocaine with epinephrine. Make a skin wheal but also get the deeper structures laterally.
2) Crush the canthus.
Direct a straight Kelly / hemostat laterally across the lateral canthus and clamp for about 1 to 2 minutes to devascularize and reduce bleeding.
3) Cut the canthus.
Raise the skin with forceps and use the iris scissors to make a I to 2 cm incision laterally across the canthus. This is the canthotomy.
4) Pull the eyelid.
Using toothed forecep, pull the lower eyelid away from the globe to begin to expose the inferior crus of the lateral canthal tendon.
5) Cut the crus.
"Strum" the tissue with the scissors to identify the inferior crus. Direct the scissors inferiorly and cut through this ligament to perform the inferior cantholysis.
6) Recheck pressure.
If intraocular pressure remains elevated, the superior crus of the lateral cantonal ligament may be cut in a similar fashion.
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