Out-of-Hospital Lateral Canthotomy and Cantholysis: A Case Series and Screening Tool for Identification of Orbital Compartment Syndrome.

Orbital trauma is frequently encountered by emergency medical service (EMS) providers. Rarely, it can result in orbital compartment syndrome (OCS), an acute sight-threatening condition that requires time-sensitive intervention to preserve vision. OCS may result from an orbital mass, which in the setting of trauma may be a retrobulbar hematoma (RBH), or from edema resulting from blunt trauma or a high-energy penetrating injury in proximity to the orbit. 1 Linberg J.V. Orbital compartment syndromes following trauma. Adv Ophthalmic Plast Reconstr Surg. 1987; 6: 51-62 PubMed Google Scholar OCS may also occur subacutely from a tumor or abscess. Both medical and surgical methods exist for managing this condition. Lateral canthotomy and cantholysis (LCC) is indicated for the management of OCS. This is a simple vision-saving procedure that is well-documented and described in the literature. 2 Mcinnes G. Howes D.W. Lateral canthotomy and cantholysis: a simple, vision-saving procedure. CJEM. 2002; 4: 49-52 Crossref PubMed Scopus (43) Google Scholar , 3 Vassallo S. Hartstein M. Howard D. Stetz J. Traumatic retrobulbar hemorrhage: emergent decompression by lateral canthotomy and cantholysis. J Emerg Med. 2002; 22: 251-256 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar , 4 Ballard S.R. Enzenauer R.W. O'Donnell T. Fleming J.C. Risk G. Waite A.N. Emergency lateral canthotomy and cantholysis: a simple procedure to preserve vision from sight threatening orbital hemorrhage. J Spec Oper Med. 2009; 9: 26-32 PubMed Google Scholar The authors of this article could locate only 1 previously described case of LCC being performed in an out-of-hospital setting. 5 Hill C. Reid C. Tzannes A. Burns B. Bartlett M. Prehospital lateral canthotomy. Emerg Med J. 2013; 30: 155-156 Crossref PubMed Scopus (7) Google Scholar This case series describes the care of 3 patients who suffered separate traumas, 2 motor vehicle accidents and 1 fall from standing height, in the years 2016 and 2017 who had emergent LCC in the field by physicians staffing a civilian rotary wing air ambulance. LCC is generally not included as a skill within the scope of practice of EMS providers. These cases highlight the difficulty of accurately identifying OCS in an out-of-hospital setting. A method for screening patients for OCS is described, as well as the logistics of performing LCC in an out-of-hospital setting. Robert Whitford, MD, is a third-year emergency medicine resident at the University of Cincinnati and a flight physician with UC Health Air Care in Cincinnati, OH. Sara Continenza, MD, is a third-year emergency medicine resident at the University of Cincinnati and a flight physician with UC Health Air Care. Jeremy Liebman, MD, is a third-year emergency medicine resident at the University of Cincinnati and a flight physician with UC Health Air Care. Jason Peng, ACNP, is a nurse practitioner with UC Health Air Care. Elizabeth K. Powell, MD, is an attending physician and assistant professor of emergency medicine at the University of Cincinnati, a flight physician with UC Health Air Care and Mobile Care, the associate medical director of Air Care, and the medical director of Mobile Care. Peter V.R. Tilney, DO, FACEP, EMT-P, is a board-certified emergency physician at Central Maine Medical Center in Lewiston. He is also a medical director for LifeFlight of Maine and can be reached at [email protected]