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Question 14#

Two hours after blepharoplasty a 60-year-old hypertensive man complains of a swollen, painful right eye and decreased visual acuity. On examination, he has proptosis of the right eye with decreased vision when compared to the left eye. The most appropriate management includes:

A. Head elevation and ice packs
B. Antihypertensive medication
C. Diuretics and pain medication
D. Canthotomy, mannitol and acetazolamide
E. Consultation with an ophthalmologist

Correct Answer is D

Comment:

Canthotomy, mannitol and acetazolamide. This man has a retrobulbar haematoma which if not treated immediately will lead to blindness. This is a true emergency and if the patient’s eyesight is to be saved, immediate and decisive treatment is imperative. There is no time to wait for an ophthalmology consult. Head elevation and ice packs, diuretics and pain medication, and hypertensives are of no immediate value. There is no time to even return to the operating room. Immediate canthotomy to decompress the orbit, with intravenous infusion of acetazolamide and mannitol to reduce intra-ocular pressure, are the emergency treatment. After that, consultation with ophthalmology and all the other options are certainly appropriate. However, for the immediate handling of this acute emergency, D is the only appropriate option.