Midway through nucleus emulsification, a 58-year-old patient suddenly complains of severe pain and restlessness. The anterior chamber shallows, intraocular pressure rises sharply, the red reflex darkens, and the wound gapes. What is the immediate priority of management?

• A Continue phacoemulsification at low vacuum to remove the remaining nucleus quickly
• B Inject pilocarpine into the anterior chamber and wait for the chamber to deepen
• C Immediately stop surgery, seal all incisions with sutures, and consider posterior sclerotomy or vitrectomy as guided by a vitreoretinal team ✓
• D Perform an urgent lateral canthotomy to decompress the orbit

Explanation

These findings indicate expulsive suprachoroidal haemorrhage. The correct response is immediate abandonment of the procedure, tamponade of the wound with sutures or the surgeon's finger, and intravenous osmotic agents, followed by posterior sclerotomy or delayed vitreoretinal drainage if needed. Continuing surgery or waiting for spontaneous deepening risks extrusion of ocular contents. Lateral canthotomy treats orbital compartment syndrome, not suprachoroidal bleeding.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.