Fist10EM - By Justin Morgenstern - March 13, 2023
The lateral canthotomy is a core emergency medicine procedure. It was one of the earliest topics covered on First10EM. Early intervention improves outcomes, but despite that, ED physicians frequently delay performing the procedure until the arrival of a specialist. (Beams 2016) A “one-snip” approach has been described that, based on limited cadaveric studies, is equally effective at relieving intraocular pressure while simplifying the procedure. (Blandford 2018; Yarter 2023) (A related procedure, called the ‘vertical split’ adds a second cut through the upper eyelid, and is widely used for elective surgeries, as well as having cadaveric evidence of efficacy.) (Elpers 2020) Although the evidence is limited, the anatomic effect is identical, and failure is immediately identifiable (no decrease in intraocular pressure), allowing one to proceed with a more traditional surgical approach. Therefore, I think this is a reasonable first technique for this rare, vision threatening emergency.