• Kenneth V Iserson, Zelda Luke-Blyden, and Scott Clemans.
• Department of Emergency Medicine, University of Arizona, Tucson, AZ; GPHC Emergency Medicine Residency, Georgetown, Guyana (Dr Iserson). Electronic address: kvi@u.arizona.edu.
• Wilderness Environ Med. 2016 Mar 1; 27 (1): 85-91.

AbstractOrbital 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. Copyright © 2016 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

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