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You are seeing a 15 year old who sustained significant facial trauma. He complains of decreased vision in his right eye. On exam you note proptosis, periorbital swelling, and relative afferent pupillary defect (aka Marcus-Gunn pupil) on the left. The intraocular pressure is measured at 45.
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February 28, 2023 at 11:56 pm
E) Transect the inferior crus of the lateral canthal ligament
Lateral canthotomy involves cutting the lateral canthal ligament, usually the inferior crus and sometimes also the superior crus. This is an emergent procedure to treat orbital compartment syndrome, which is vision-threatening; the procedure should not be delayed for the arrival of an ophthalmologist. Signs of orbital compartment syndrome include: decreased visual acuity, proptosis, relative afferent pupil defect, diffuse subconjunctival hemorrhage, eyelid feels “rock hard” when palpated.