title: Orbital Compartment Syndrome: Alternative Tools to Perform a Lateral Canthotomy and Cantholysis.
abstract: Orbital compartment syndrome acutely threatens vision. Lateral canthotomy and cantholysis ameliorate the compartment syndrome and, to save a patient's vision, must be performed in a timely manner. This requires appropriate tools. In resource-poor settings, the straight hemostat and iris scissors that are generally used for this procedure may be unavailable. In such situations, safe alternatives include using a multitool in place of a hemostat and a #11 scalpel blade instead of the iris scissors. As when using hemostats of varying sizes, the pressure applied to the multitool must be carefully modulated. When using a scalpel blade for the lateral canthotomy, the hemostat arm remains beneath the lateral canthus as a "backstop" to protect deeper tissues. For the cantholysis, use the back of the blade to "strum" for the ligaments, reversing its direction only to cut the ligament when it is identified.
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, AZ; GPHC Emergency Medicine Residency, Georgetown, Guyana (Dr Iserson). Electronic address: kvi@u.arizona.edu.
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Iserson
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, AZ; Department of Emergency Medicine, Georgetown Public Hospital Corporation, Georgetown, Guyana (Dr Luke-Blyden).
authors.forename: Zelda
authors.initials: Z
authors.lastname: Luke-Blyden
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, AZ; Buecher Biological Consulting, Tucson, AZ (Mr Clemans).
authors.forename: Scott
authors.initials: S
authors.lastname: Clemans
mesh_terms: D003161:Compartment Syndromes / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007765:Lacrimal Apparatus / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation*; D009915:Orbit / Q000293:injuries* / Q000473:pathology; D011312:Pressure; D016896:Treatment Outcome
keywords: cantholysis; lateral canthotomy; ophthalmic trauma; orbital compartment syndrome; retrobulbar hematoma