Facial trauma is a common cause for presentation to emergency departments [1]. Vision loss after facial trauma can occur due to a variety of conditions, including orbital compartment syndrome (OCS) [2]. The orbital compartment is defined by the closed space bordered by the orbital bones posteriorly, laterally, and medially, and the eyelid apparatus (orbital septum and the canthal ligaments) anteriorly [3]. Orbital compartment syndrome occurs when the pressure in this closed space (the intraorbital pressure) rises. This rise in pressure is usually due to accumulation of blood product [4], but can occur in a variety of settings, including fulminant orbital cellulitis [5], a prolonged period in prone positioning [6,7], severe burns with or without aggressive fluid resuscitation [8,9], and orbital emphysema [10]. In experimental models, the change in intraorbital pressure can be measured directly [11,12], but in the clinical environment measuring the orbital pressure is not practical, thus intraocular pressure (IOP) is obtained as a proxy [13]. The rise in intraorbital pressure leads to compression of the optic nerve and the vessels within, leading to ischemia, irreversible optic nerve damage, and vision loss [5]. The vision loss can be severe and rapid, necessitating prompt treatment. In fact, some studies suggest a necessity to treat within two hours [14,15]. Patients with OCS typically present to the emergency department where emergency medicine (EM) providers are often called upon to initiate treatment measures. Other subspecialists (ophthalmologists, otolaryngologists, etc.) working at the hospital of presentation may also be called upon to help treat these patients.

While medical therapy is sometimes used to treat orbital compartment syndrome, it is rarely used in isolation [16]. The definitive treatment for orbital compartment syndrome is to surgically open the closed space, allow evacuation of orbital contents (blood, pus, etc.), and thus reduce the intraorbital pressure. There are multiple surgical procedures described in the literature to treat OCS, including lateral canthotomy alone [11], lateral canthotomy with an inferior cantholysis alone or combined with a superior cantholysis [[11], [12], [13],[16], [17], [18]], septolysis or inferior orbital septum release [12], vertical lid split [18], bony orbital decompression [15], and hematoma evacuation [14].

Our study focuses mainly on the lateral canthotomy and cantholysis (C&C), which in our experience is the most common procedure pursued by providers. Several, mainly cadaveric model-based studies have shown efficacy of a lateral C&C [[11], [12], [13],[16], [17], [18]]. However, despite its efficacy, there is often hesitancy amongst providers, particularly EM providers, to perform it [4]. Additionally, to our knowledge there is no literature to describe the real-life success rates of the lateral C&C. Our study investigates the initial success rates of the lateral C&C for the treatment of OCS amongst EM and ophthalmology providers. As the only level 1 trauma center in a multi-state region which receives most patients with OCP in the region, some having received treatment prior to arrival and some who have not, we are uniquely equipped to address the question of real-world lateral C&C success rate.