to the editor: The article1 in the April 1, 2003 issue of American Family Physician by Rodriguez and colleagues provides a practical outline of the approach to sports-related eye injuries. I found Table 3, which discussed the treatment of selected eye injuries, to be particularly useful. I would like to expand on the use of emergent lateral canthotomy in cases of blunt trauma. In these cases, if the globe is proptotic and tense, the physician should suspect a retrobulbar hematoma.2,3 Failure to recognize this condition can lead to optic nerve ischemia and resultant vision loss.
Orbital pressure can be relieved with a lateral canthotomy. To perform this procedure, a small amount of local anesthetic is injected in the region of the lateral canthal tendon. A straight hemostat is placed in the region between upper and lower lids, thereby causing a crush injury to the lateral canthus. Using scissors (e.g., Straight Stevens), a cut is made across the hemostatic line to the level of the lateral orbital rim. Further orbital decompression is facilitated by performing cantholysis through blunt dissection. The clinical usefulness of this procedure was made evident to me while on duty in the emergency department. A 20-year-old man was evaluated after a blunt force injury to his left eye. His globe was proptotic and tense, and he had only light perception. The lateral canthotomy procedure was performed, and his vision was restored to 20/40. Knowledge of this procedure is a must for physicians, especially those in remote areas where access to ophthalmology is not readily available. The emergent lateral canthotomy can be a potentially sight-saving procedure.
editor’s note: Obviously, the procedure described should only be tried by those with appropriate surgical experience, or in times of emergency when no other resources are available.