Orbital Compartment Syndrome: Alternative Tools to Perform a Lateral Canthotomy and Cantholysis

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.