What are the indications for lateral canthotomy and cantholysis?

Updated: Jun 11, 2020
  • Author: Anna G Gushchin, MD; Chief Editor: Edsel B Ing, MD, MPH, FRCSC, PhD, MA  more...
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Answer

Answer

Lateral canthotomy and cantholysis should be performed for ocular compartment syndrome (most commonly caused by retrobulbar hemorrhage) with acute loss of visual acuity, relative afferent pupillary defect, increased IOP, and proptosis. [12] In the unconscious or uncooperative patient, an IOP greater than 40 mm Hg, especially with a relative afferent pupillary defect, is an indication for lateral canthotomy (normal IOP is 10-21 mm Hg). [13]

Lateral canthotomy may also be considered in patients with retrobulbar hemorrhage along with any of the following: ophthalmoplegia, cherry-red macula, optic nerve head pallor, and severe eye pain.

Glaucoma drops do not decrease intraorbital pressure.

Prompt (< 90-120 minutes) completion of lateral canthotomy and cantholysis is associated with better visual outcomes, although delayed treatment (3 hours) has still yielded some visual recovery after lateral canthotomy/cantholysis. Therefore, all patients with acute ocular compartment syndrome should be considered for prompt lateral canthotomy and cantholysis. [2, 14]


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