A 6-year-old child sustains blunt orbital trauma and develops progressive proptosis, severe periorbital ecchymosis, and restriction of all extraocular movements within 2 hours. CT reveals no obvious fracture but demonstrates intraorbital haemorrhage with a dark crescentic subperiosteal mass. The MOST urgent intervention is:

• A Canthotomy and cantholysis of the inferior crus of the lateral canthal tendon to decompress the orbit ✓
• B Systemic corticosteroids and observation for 24 hours
• C Medial orbital wall decompression via endoscopic approach
• D MRI of the orbit to better characterise the haematoma

Explanation

Orbital compartment syndrome with rising IOP, proptosis, ophthalmoplegia, and evidence of orbital haematoma in a child requires immediate orbital decompression. Lateral canthotomy and inferior cantholysis releases the inferior crus of the lateral canthal tendon, immediately expanding the orbital volume and reducing pressure on the optic nerve. This is an emergency bedside procedure. Delay for imaging or conservative management risks permanent optic nerve damage from ischaemia. Endoscopic decompression is reserved for subacute settings.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.