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

Am J Emerg Med. 2023 Aug;70:140-143. doi: 10.1016/j.ajem.2023.05.037. Epub 2023 Jun 1.


Purpose: 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.

Methods: 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 mmHg after the first attempt at the procedure. Inclusion criteria included documentation of a procedural attempt, a pre-procedure IOP >30 mmHg and a post-procedure IOP measurement; or alternatively if no pre-procedure IOP was documented but the IOP was >30 on arrival to the level 1 trauma center. Exclusion criteria included periprocedural use of ocular hypotensive medications and comorbid hyphema.

Results: 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% vs 79.2%, 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.

Conclusions: The success rate of a lateral C&C is comparable amongst EM and ophthalmology providers. Improved training of physicians on the lateral C&C or other simpler procedures, such as the vertical lid split, could improve outcomes in OCS.

Keywords: Intraocular pressure; Intraorbital pressure; Lateral canthotomy and cantholysis; Orbital compartment syndrome; Vertical lid split.

MeSH terms

  • Compartment Syndromes* / etiology
  • Compartment Syndromes* / surgery
  • Craniocerebral Trauma*
  • Humans
  • Orbit / injuries
  • Orbit / surgery
  • Orbital Diseases* / surgery
  • Retrospective Studies