TO THE EDITOR: The article (1) in t...

TO THE EDITOR: The article (1) in the April 1 2003 issue of American Family Physician at Rodriguez and colleagues provides a practical outline of the approach to sports-related inspection injuries. I found Table 3 which discussed the treatment of selecteded eye injuries, to be particularly useful. I would like to expand forward the use of emergent lateral canthotomy in cases of dull-witted trauma. In these cases, if the globe is proptotic and tight the physician should suspect a retrobulbar hematoma. (23) Failure to recognize this condition can lead to optic resolution ischemia and resultant vision loss

Orbital squeezing can be relieved with a lateral canthotomy. To perform this course a small amount of local anesthetic is injected in the region of the lateral canthal tendon. A straight hemostat is placed in the region between upper and lower lids, thereby causing a crush injury to the lateral canthus. Using scissors (eg Straight Stevens) a intersect is made across the hemostatic line to the horizontal of the lateral orbital rim. Further orbital decompression is facilitated by the agency of performing cantholysis through blunt dissection. The clinical usefulness of this course was made evident to me while in succession duty in the emergency department. A 20-year-old man was evaluated after a thick-witted force injury to his left judgment His globe was proptotic and rigid and he had only light perception. The lateral canthotomy measure was performed, and his vision was restored to 20/40 Knowledge of this act is a must for physicians, especially those in unconnected unrelated areas where access to ophthalmology is not readily available. The emergent lateral canthotomy can be a potentially sight-saving procedure

MARK D BENTON, DO

Department of Family Practice

Naval Hospital Pensacola

Pensacola, FL 32512-0003

REFERENCES

(1) Rodriguez JO Lavina AM, Agarwal A. Prevention and treatment of for the use of all eye injuries in sports. Am Fam Physician 2003;67:1481-8

(2) Ellis E 3d Scott K Assessment of patients with facial fractures. In: Rutkauskas J Redding SW Mulliken RA. Oral-facial emergencies. pressing necessity medicine clinics of North America 2000;18:411-48

(3) Vassallo s Hartstein M, Howard D, Stetz J Traumatic retrobulbar hemorrhage: emergent decompression by the agency of lateral canthotomy and cantholysis. J Emerg M 2002;22:251-6

The opinions and assertions contained herein are the private views of the author and are not to be constru as official or as reflecting the views of the U Navy Medical Department or the U Navy Service at large.

EDITOR'S NOTE: Obviously, the course described should only be tried by dint of those with appropriate surgical experience, or in times of unforeseen occasion when no other resources are available.

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group