FOLLOW-UP PROTOCOL FOR PTS S/P LATERAL C&C
Goal: to decrease vision loss due to compressive optic neuropathy and ensure appropriate follow up for patients who underwent lateral canthotomy & cantholysis (C&C)
Process:
1. Burn patient with high IOP pre-op (35) in settings of high fluid rate/low UOP
- Emergent C&C. Document emergent nature, and pre-C&C lid tension.
- Check and document IOP immediately after C&C. Note if lids are freely mobile.
- If IOP 22 – check and document IOP again 6-8 hours post-op then every day until fluid rate is decreased/pt makes good UOP.
- If IOP > 22 – start IOP drops, check and document IOP every 2-3 hours until IOP 22 and fluid rate is decreased/pt makes good UOP.
- Follow up with ophthalmology within 10 days (if patient remains in ICU can take a photo and staff with oculoplastic fellow/attendings) to assess for need for repair.
2. Patient with retrobulbar hemorrhage with high IOP (>35)
- Emergent C&C. Document emergent nature.
- Check and document IOP immediately after C&C.
- If IOP 22 6 hours after the initial injury – OK to discharge.
- If IOP 22 – start IOP drops, check and document IOP every hour until the 6 hour mark.
- Follow up with ophthalmology within 10 days (if patient remains in ICU can take a photo and staff with oculoplastic fellow/attendings) to assess for need for repair.
*IOP drops = latanoprost, brimonidine and cosopt (timolol/dorzolamide)