Orbital Compartment Syndrome: Alternative Tools to Perform a Lateral Canthotomy and Cantholysis Kenneth V. Iserson, MD, MBA, Zelda Luke-Blyden, MD, Scott.

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Orbital Compartment Syndrome: Alternative Tools to Perform a Lateral Canthotomy and Cantholysis Kenneth V. Iserson, MD, MBA, Zelda Luke-Blyden, MD, Scott Clemans, BSME Wilderness & Environmental Medicine Volume 27, Issue 1, Pages 85-91 (March 2016) DOI: 10.1016/j.wem.2015.09.002 Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 1 Orbit, globe, and adjacent structures. (Peter J. Lynch, Medical Illustrator, Creative Commons. Uploaded Dec. 23, 2006). Wilderness & Environmental Medicine 2016 27, 85-91DOI: (10.1016/j.wem.2015.09.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 2 Soft tissue structures around the anterior globe. Wilderness & Environmental Medicine 2016 27, 85-91DOI: (10.1016/j.wem.2015.09.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 3 Steps in a lateral canthotomy and cantholysis. A, Arrow: Site for anesthetic and crushing lateral orbital tissue. B, Cut lateral canthal tendon with scissors or knife. C, Pull the lower eyelid down, strum, and cut inferior tendons. Permission for photo montage (captions changed): Sarwark J. Procedures in Lateral Canthotomy. www.emcurious.com/blog-1/2014/9/25/the-lateral-canthotomy. Accessed August 29, 2015. Wilderness & Environmental Medicine 2016 27, 85-91DOI: (10.1016/j.wem.2015.09.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 4 Description of force applied by hemostats and multitools. The clamping force varies with the placement of the operator’s hand on the instrument and the pressure applied to the handle. Wilderness & Environmental Medicine 2016 27, 85-91DOI: (10.1016/j.wem.2015.09.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 5 Lateral canthotomy with multitool and #11 blade. Wilderness & Environmental Medicine 2016 27, 85-91DOI: (10.1016/j.wem.2015.09.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions

Figure 6 “Strumming” tendons with dull side of a #11 blade. Wilderness & Environmental Medicine 2016 27, 85-91DOI: (10.1016/j.wem.2015.09.002) Copyright © 2016 Wilderness Medical Society Terms and Conditions