Abstract
Purpose :
Orbital compartment syndrome (OCS) is a sight-threatening condition that requires emergent intervention to prevent permanent vision loss. Intervention is frequently delayed due to unfamiliarity with the diagnosis and management of this condition. Even when the condition is diagnosed correctly, emergency personnel often perceive bedside orbital decompression as technically difficult and daunting. Due to this, treatment is usually delayed and irreversible loss of vision occurs. This prospective, cross sectional study is the first of its kind as it surveyed training and attending ophthalmologists and emergency medicine (EM) physicians regarding their knowledge and comfort level with OCS and the emergent interventions available. We hypothesize that once emergency personnel are educated about the vertical lid split (VLS), an alternate, less technically difficult method, this may reduce the number of cases of OCS in which sight has been lost due to delay in orbital decompression.
Methods :
Ophthalmologists and EM physicians were surveyed from multiple sites (VCU, UPMC, Rush and affiliated sites) after watching a video regarding OCS. The survey contained 15 questions on OCS, as well as a question regarding which treatment approach the participant preferred in the acute management of OCS: VLS or lateral canthotomy and cantholysis (LCC).
Results :
A total of 177 surveys were collected across the 3 sites. 19.8% participants were attending EM physicians, 2.3% were EM fellows, 29.2% were EM residents, 33.3% were attending ophthalmologists, 4.5% were ophthalmology fellows, and 23.7% were resident ophthalmologists. 85.3% of the respondents were not aware of this alternative intervention for OCS. 82.5% participants answered that even after learning about this alternative, less technically difficult method, they would still more likely perform a LCC over a VLS when treating OCS.
Conclusions :
LCC is still the preferred method among EM personnel and ophthalmologists in treating OCS despite being more technically difficult and time-consuming than the VLS approach. Given this insight, we recommend more formalized educational initiatives focused on the technicalities of this procedure to ensure that it is being appropriately utilized clinically versus just remaining as an underutilized textbook entity.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.