Patient Selection

This technique is typically applicable to cooperative pediatric and adult patients who will allow the insertion of a Morgan lens onto their cornea. In the case of an uncooperative patient, procedural sedation may be used in order to successfully and safely perform the procedure. The use of a paper clip and Morgan lens remains very valuable after procedural sedation and prior to the onset of the lateral canthotomy.

Caution

A 2002 Canadian Journal of Emergency Medicine article by McInnes and Howe reports several complications of lateral canthotomy, ranging from minor postoperative bleeding and infection to the most-feared complication, iatrogenic globe rupture.³ Our proposed technique for performing a lateral canthotomy and cantholysis protects against iatrogenic globe rupture. However, it potentially increases the risk of corneal abrasions due to placing the Morgan lens over the cornea. In a risk-benefit analysis, most providers would opt for a corneal abrasion as opposed to an iatrogenic globe rupture. The Morgan lens also provides a sense of comfort by having a physical barrier present during this critical procedure and period of high stress.

Caution should be exercised when placing topical anesthetic drops into the eyes of patients who have suffered a caustic injury. A litmus-paper test to determine the pH prior to placing the drops should be performed because topical anesthetic drops, in theory, could lower the pH, leading to worsening injury or permanent vision loss.⁴

Dr. McGovern is an emergency medicine resident at St. Joseph’s Regional Medical Center in Paterson, New Jersey.

Dr. McNamee is chief resident of the emergency medicine residency at St. Joseph’s Regional Medical Center in Paterson, New Jersey.

Dr. Patel is associate program director, emergency medicine, at St. Joseph’s.

References

1. Lima V, Burt B, Leibovitch I, et al. Orbital compartment syndrome: the ophthalmic surgical emergency. Surv Ophthalmol. 2009;54(4):441-449. Oester AE Jr, Fowler BT, Fleming JC.
2. Oester AE Jr, Fowler BT, Fleming JC. Inferior orbital septum release compared with lateral canthotomy and cantholysis in the management of orbital compartment syndrome. Ophthal Plast Reconstr Surg. 2012;28(1):40-43.
3. McInnes G, Howes D. Lateral canthotomy and cantholysis: a simple, vision-saving procedure. CJEM. 2002;4(1):49-52.
4. Bord SP, Linden J. Trauma to the globe and orbit. Emerg Med Clin North Am. 2008;26(1):97-123.
5. Carrim ZI, Anderson IW, Kyle PM. Traumatic orbital compartment syndrome: importance of prompt recognition and management. Eur J Emerg Med. 2007;14(3):174-176.