The Halloween Lateral Canthotomy Model
The Halloween lateral canthotomy model is designed to instruct emergency medicine residents PGY 1-4, as well as emergency medicine-bound students.
Although uncommon, retrobulbar hemorrhage associated with facial trauma is a potential cause of permanent vision loss due to orbital compartment syndrome. To prevent vision loss, treatment with lateral canthotomy is time-sensitive and to perform this procedure in an emergent setting requires properly trained practitioners.
The purpose of the model is to teach residents and students how to perform lateral canthotomy and to achieve competency in their skills. By the end of this instructional session learners should be able to: 1) Discuss the indications, contraindications and complications associated with the procedure, and 2) be able to perform cantholysis via lateral canthotomy on simulated models.
Lateral canthotomy is an important skill to be proficient in for any emergency medicine physician, as it is an uncommon, sight-saving procedure. It is indicated in scenarios of facial trauma that cause a retrobulbar hemorrhage. Patients are at risk for permanent vision loss due to acute orbital compartment syndrome if the procedure is not done expeditiously.1 A less likely cause of retrobulbar hemorrhage is spontaneous hemorrhage due to a bleeding disorder or anticoagulant use.2 The features of retrobulbar hemorrhage include acute loss of visual acuity, relative afferent pupillary defect, proptosis with resistance to retropulsion, increased intraocular pressure, and limited extra ocular movement.3 While the diagnosis is clinical, it can be confirmed by computed tomography (CT) and measurement of intraocular pressure.2 When the diagnosis is established, lateral canthotomy and cantholysis should be performed emergently. Cantholysis is contraindicated when a globe rupture is suspected or with an orbital blowout fracture. Potential complications of this procedure include iatrogenic injury to the globe or lateral rectus muscle, damage to the elevator aponeurosis resulting in ptosis, injury to the lacrimal gland and lacrimal artery, bleeding and infection.3 This task trainer uses affordable materials to let learners practice this rare, vision saving procedure.
Visual acuity, eye trauma, retrobulbar hemorrhage, relative afferent pupillary defect