A 30-year-old man presents with a 3-day history of progressive left-sided proptosis, ophthalmoplegia, and decreasing vision following a retrobulbar hemorrhage after trauma. Intraocular pressure is elevated at 45 mm Hg, and there is a relative afferent pupillary defect. The most urgent intervention is:
- A Intravenous methylprednisolone
- B Orbital decompression via endoscopic sinus surgery
- C Lateral canthotomy and inferior cantholysis ✓
- D Anterior chamber paracentesis
Correct answer: C. Lateral canthotomy and inferior cantholysis
Explanation
This presentation is classic for orbital compartment syndrome, a sight-threatening emergency requiring immediate decompression. Lateral canthotomy and inferior cantholysis is the bedside emergency procedure to rapidly reduce orbital pressure and restore optic nerve perfusion. Intravenous steroids, orbital decompression surgery, and anterior chamber paracentesis are not appropriate first-line interventions for this acute compartment syndrome.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.