Canthotomy

FreezingLateralCanthus

CuttingLateralCanthus

Canthotomy is a surgical procedure involving the cutting of the canthus, specifically the outer or lateral canthus, which is the fold of tissue at the corner of the eye where the upper and lower eyelids meet. This procedure is often performed as an emergency intervention to relieve intraocular pressure in cases of orbital compartment syndrome, a condition that can lead to permanent vision loss if not promptly treated. Canthotomy can also be part of reconstructive surgery following trauma or in the management of certain eyelid tumors.

Indications

The primary indication for a canthotomy is the acute management of orbital compartment syndrome. This condition is characterized by a significant increase in pressure within the orbit, often due to trauma, hemorrhage, or severe infection, which can compress the optic nerve and ocular blood vessels, leading to vision loss. By cutting the canthus, the procedure aims to release the pressure and prevent further damage to the eye and surrounding structures.

Other indications may include the need for improved surgical access to the orbit and eyelids for the removal of tumors or foreign bodies, or the reconstruction of the area following trauma.

Procedure

A canthotomy involves the surgical division of the lateral canthus. It is typically followed by a cantholysis, where the inferior or sometimes both the inferior and superior crus of the lateral canthal tendon are cut. This further releases tension and pressure within the orbit.

The procedure is usually performed under local anesthesia, although general anesthesia may be used in certain cases, especially if the patient is unconscious or in cases involving significant trauma.

1. The area around the eye is cleaned and sterilized. 2. Local anesthetic is administered to numb the area. 3. A small incision is made at the lateral canthus. 4. The lateral canthal tendon is identified and cut, either partially (inferior cantholysis) or completely (inferior and superior cantholysis), depending on the indication. 5. The wound may be left open to heal by secondary intention or sutured closed, based on the clinical scenario and surgeon's preference.

Complications

While canthotomy and cantholysis are generally safe, as with any surgical procedure, there are potential complications. These may include:

- Infection - Bleeding - Scarring - Asymmetry of the eyelids - Damage to the lacrimal (tear) system - Need for further surgery or revision

Recovery

Postoperative care involves keeping the area clean and applying topical antibiotics to prevent infection. The patient is usually advised to avoid rubbing the eye and to monitor for signs of infection or other complications. Follow-up appointments are necessary to assess healing and the need for any additional treatment.

Conclusion

Canthotomy, often performed alongside cantholysis, is a critical emergency procedure in the management of orbital compartment syndrome. It can also be utilized in various other surgical interventions involving the eye and its surrounding structures. Despite its potential complications, the procedure plays a vital role in preserving vision and preventing long-term ocular damage.