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DIAGNOSIS:
Visual loss in the left was consistent with compression of the
optic nerve from an orbital process. Because there were
no other signs of a carotid-cavernous fistula and the patient
was at high risk for progressive visual loss, a more extensive
lateral canthotomy and inferior cantholysis was indicated
before the patient could undergo a high resolution orbital computed
tomographic (CT) scan at our institution.
TREATMENT:
An emergent lateral canthotomy
and inferior cantholysis was
performed in our emergency department, which resulted in drainage
of blood-tinged, greenish-yellow liquid. The lid edema and
proptosis partially improved after the canthotomy and cantholysis.
The intraocular pressure decreased to 26 mm Hg OS. The patient’s
visual acuity remained 20/400 OS. The patient was given ampicillin/sulbactam,
1.5 g IV, q 6 h; acetazolamide, 250 mg, po, q 6 h; and timolol ophthalmic,
0.5%, bid, OS, before undergoing a CT scan (with contrast) of the
orbits and face. |
