Success rates of lateral canthotomy and cantholysis for treatment of orbital compartment syndrome

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N. Maxwell Scoville, MD
Leona Ding, MS
Andrew W. Stacey, MD


Vision loss after facial trauma can occur from orbital compartment syndrome (OCS). Orbital compartment syndrome is commonly treated surgically with a lateral canthotomy and cantholysis (C&C). Our study investigates success rates of lateral C&C for the treatment of OCS amongst emergency medicine (EM) and ophthalmology providers.
A retrospective cohort study was performed. Cases were identified and the electronic medical record of patients was interrogated for clinical and procedural information. Success of a lateral C&C was defined as a decrease in intraocular pressure (IOP) to <30 mm Hg after the first attempt at the procedure. Inclusion criteria included documentation of a procedural attempt, a pre-procedure IOP >30 mm Hg and a post-procedure IOP measurement; or alternatively if no pre-procedure IOP was documented but the IOP was >30 mm Hg on arrival to the level 1 trauma center. Exclusion criteria included periprocedural use of ocular hypotensive medications and comorbid hyphema.
The final analysis included 74 eyes from 64 patients. Emergency medicine providers performed the initial lateral C&C in 68% of cases compared to 32% by ophthalmologists, and success rates were comparable—68% versus 79%, respectively (P = 0.413). Poorer visual outcomes were associated with the initial failure of a lateral C&C and head trauma without an orbital fracture. All patients treated with a vertical lid split procedure met the criteria for “success” as defined by this study.
The success rate of a lateral C&C is comparable amongst EM and ophthalmology providers. Initial failure of a lateral C&C is associated with worse visual outcomes. Improved training of physicians on the lateral C&C or other simpler procedures, such as the vertical lid split, could improve outcomes in OCS.


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How to Cite
Scoville NM, Ding L, Stacey AW. Success rates of lateral canthotomy and cantholysis for treatment of orbital compartment syndrome. Digit J Ophthalmol. 2024;30. Accessed July 21, 2024.