Consider sedating patient for procedure, if time allows
Prep and drape the area (Irrigation with normal saline is acceptable prep given emergent nature of procedure)
Inject lidocaine with epinephrine into the lateral canthus directing the needle tip toward the lateral orbital rim (away from the globe)
Apply hemostat to the lateral canthus from the angle of the eye to the orbital rim and clamp shut for ~1 min. (provides relative devascularization as well as a landmark for the<unk> 
Using scissors, incise the lateral canthus from the angle of the eyelid to the orbital rim (~1cm).
Retract the inferior lid and bluntly dissect tissue until the canthal tendon is identified.
Perform inferior cantholysis - cut the inferior crus of the lateral canthus tendon (point scissors infero-posteriorally toward the lateral orbital rim, avoiding the globe)
Recheck IOP → if still elevated, perform superior cantholysis - cut the superior crus of the canthal tendon (some experts recommend performing both inferior and superior cantholysis at the same time, prior to re-evaluating IOP)
improved visual acuity
resolution of afferent pupillary defect
decrease in IOP to <40 mm Hg
Canthotomy
Cerumen removal
Iridodialysis
Hydrocortisone topical
Triamcinolone acetonide
Ciclesonide
Extracorporeal membrane oxygenation
Desonide