However, these patients have a compartment syndrome of the eye (involving the globe, the ophthalmic artery, and the optic nerve), and it is your job at this point to prevent the patient from having permanent vision loss. The setup is minimal and brief, as time = retina in this situation, and if the specialist isn't going to be in for a while you're responsible for this one. The literature suggests that after the initial loss of vision, you have about 120 minutes until the loss is permanent.



Quickly throw a few cc's of lido with epinephrine into the lateral canthus, and then squeeze it with a hemostat to reduce bleeding. Then snip through the canthus toward the orbital rim. Pull down and locate the inferior crus of the lateral canthal ligament (this is the cantholysis of the procedure, visualized with the cadaver image below). Recheck your IOP at this time--if it's still elevated you can snip the superior crus as well.

