Identify the lateral canthus.
Cleanse the area with antiseptic and anesthetize with 1% lidocaine with epinephrine.
Crush the canthus with a hemostat for 1-2 minutes to reduce incisional bleeding.
Cut through the crushed tissue with iris scissors to open up the canthus
Pull the lower eyelid away from the globe with toothed forceps.
“Strum” the tissue under the canthotomy with the scissors to identify the inferior crus of the lateral canthal ligament. Cut through this ligament with scissors directed inferiorly (perpendicular to the canthotomy incision).
Re-check intraocular pressure (IOP).
If IOP remains high (>40), the superior crus of the lateral canthal ligament may be cut in a similar manner.
Consult ophthalmology for repair and definitive management.