A patient has a retrobulbar hematoma that is impairing vision; what is the treatment?

In cases of retrobulbar hematoma, particularly when vision is impaired, timely intervention is crucial to prevent permanent vision loss. The appropriate treatment in this scenario is a lateral canthotomy. This procedure involves an incision made in the lateral canthus of the eye, which helps to relieve the pressure caused by the hematoma by allowing for decompression of the orbit.

Pressure within the eye and orbit can lead to ischemia of the optic nerve, resulting in potential blindness. The lateral canthotomy is a rapid and effective way to alleviate this pressure, restoring blood flow and potentially salvaging vision. It is especially beneficial in emergency situations where immediate intervention is required.

While other options like immediate surgery or corticosteroids may be considered in some contexts, they do not address the urgent need for pressure relief in a retrobulbar hematoma affecting vision. Observation is also not viable in this situation, as it risks the patient's sight due to the compromised vascular supply to the optic nerve. Thus, the lateral canthotomy stands out as the most effective and immediate treatment option.