Lateral Canthotomy Set

What condition is a lateral canthotomy used to treat?

Lateral canthotomy and cantholysis is the emergency treatment for orbital compartment syndrome — most commonly caused by a retrobulbar hematoma following blunt orbital trauma or penetrating eye injury. The accumulation of blood behind the eye increases intraorbital pressure, compressing the optic nerve and central retinal artery. Without decompression within 60–120 minutes, permanent vision loss can result. The lateral canthotomy releases the lateral canthal tendon to reduce orbital pressure and restore optic nerve perfusion.

Who is qualified to perform a lateral canthotomy with this kit?

Lateral canthotomy is a surgical procedure that falls within the scope of practice of emergency physicians, surgeons, ophthalmologists, and advanced military medics (particularly 18D Special Forces Medics) with Prolonged Casualty Care training. Some flight programs and critical care transport services also include this skill. It is not appropriate for general BLS or standard AEMT providers. The NAR kit is designed for trained clinicians who may encounter orbital compartment syndrome during extended field care without rapid specialty access.

Does the Lateral Canthotomy Set include local anesthetic?

No. The kit includes a 27-gauge tuberculin syringe for local anesthetic administration, but the anesthetic agent (typically lidocaine 1% or 2% with or without epinephrine) is not included and must be sourced separately. Local anesthesia is recommended before the procedure when time permits, as the lateral canthus area is sensitive. In emergencies where anesthetic is unavailable, the procedure can still be performed — the vision-saving benefit outweighs the discomfort.

Why does the kit include both Iris scissors and Metzenbaum scissors?

The two scissors serve different roles in the procedure. The Metzenbaum scissors (5.5 in., straight) are used to perform the canthotomy — the initial incision at the lateral canthus. The Iris scissors (4.5 in., straight) are used for the more delicate cantholysis dissection — identifying and cutting the inferior crus of the lateral canthal tendon to achieve full orbital decompression. Having both instruments allows the procedure to be performed with appropriate surgical precision at each step.

Is the lateral canthotomy part of standard TCCC or Prolonged Casualty Care training?

Lateral canthotomy is included in Prolonged Casualty Care (PCC) curricula for advanced military medics and is specifically listed as a skill for 18D Special Forces Medics and certain advanced tactical medicine programs. It is not a standard TCCC (Tactical Combat Casualty Care) skill for all levels of care, but has gained recognition as an important intervention during extended field care timelines where MEDEVAC may be delayed and orbital injuries are encountered. The NAR kit supports training programs that include this procedure.