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Canthotomy is a surgical procedure that involves the incision and dissection of the lateral canthus, the outer corner of the eye. The primary objective of a canthotomy is to alleviate pressure within the orbit, which can arise from various conditions such as trauma, hematomas, or ophthalmic emergencies where the eye is at risk of permanent damage due to increased intraocular pressure. During the procedure, the surgeon makes a careful incision through the skin and underlying tissues at the lateral canthus, either to facilitate further procedures or to create a release from the pressure by allowing fluid to escape. This technique is particularly critical in situations like orbital compartment syndrome where rapid intervention can be the difference between sight preservation and irreversible blindness. Canthotomy is typically performed under local anesthesia, providing sufficient pain management while allowing the patient to remain awake and cooperative. It is essential for the surgeon to have a thorough understanding of the anatomy of the eyelids and the surrounding structures to minimize complications and to ensure proper healing. The procedure is often accompanied by cantholysis, which involves the division of the lower eyelid retractor, thereby allowing for greater exposure and improved access to the orbit. Postoperative care is crucial, as the patient will need to be monitored for signs of infection, bleeding, or any alterations in vision. Moreover, canthotomy may sometimes be performed in conjunction with other procedures, such as drainage of orbital hematomas or to facilitate access for foreign body removal from the orbit, making it a versatile tool in the realm of ophthalmic and maxillofacial surgery. As with any surgical intervention, there are risks involved, including the potential for scarring, disruption of the eyelid function, or complications related to anesthesia. Therefore, a careful assessment of the patient's condition and the potential benefits versus risks of the procedure must be conducted prior to performing a canthotomy. In a clinical context, it is vital to understand the indications for this procedure, as it is not routinely performed but rather reserved for specific instances where other conservative measures have failed or where immediate action is necessary to preserve vision. Canthotomy remains an essential skill in the armamentarium of emergency ophthalmologic surgery and underscores the importance of prompt recognition and intervention in ocular emergencies to safeguard the health and function of the eye. As a procedure requiring both skill and knowledge, canthotomy highlights the intricacies of ocular anatomy and the need for precise technique to achieve favorable patient outcomes while minimizing risks and complications associated with surgical interventions around the eye.
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