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are more likely to find themselves in austere environmentswhere delayed evacuation would merit the needfor such skills. Teaching this subset of first respondershow to properly perform a lateral canthotomy and cantholysiswould provide them an invaluable tool to bettercare for their wounded in a timely fashion. Thistraining could occur through the use of live tissue modelsunder supervision, as occurs for emergency physiciansin their residency programs. Training 18Dmedical sergeants to recognize and treat the clinicalsigns and symptoms of OCS from retrobulbar hemorrhagevia this technique brings a potentially vision-savingintervention closer to the Soldier who is in need ofemergent care.REFERENCES1. Selezinka, W. (1988). Evaluation of the injured eye. CanFam Physician; 34:2267-2273.2. Pokhrel, P.K. and Loftus, S.A. (2007). Ocular emergencies.Am Fam Physician; 76(6):829-836.3. Law, F.W. (1971). Spontaneous orbital haemorrhage. BrJ Ophthalmol; 55(8):556-558.4. Whitwell, J. (1956). Spontaneous haematoma of theorbit. Br J Ophthalmol; 40(4):250-251.5. Roberts, W. (1955). Hematoma of the orbit. Report oftwo cases. Am J Ophthalmol; 40:215-219.6. Brooks, A.M.V. and Finkelstein, E. (1984). Spontaneousorbital haemorrhage. Br J Ophthalmol; 68:838-840.7. Kwon, J.-H., et al. (2008). Spontaneous intraorbital hemorrhage:A case report. J Korean Neurosurg Soc; 44:156-158.8. Dutton, G.N., et al. (1981). Ophthalmic consequencesof midface trauma. Eye; 6:86-89.9. Ord, R.A. (1981). Postoperative retrobulbar haemorrhageand blindness complicating trauma surgery. Br JOral Surg; 19:205-207.10. Larsen, M. and Wiesland, E.S. (1999). Acute orbitalcompartment syndrome after lateral blow-out fracture effectivelyrelieved by lateral cantholysis. Acta OphthalmolScand; 77(2):232-233.11. Long, J.C. and P.P. Ellis. (1971). Total unilateral visualloss following orbital surgery. Am J Ophthalmol;71(1):218-220.12. Krohel, G.B. and Wright, J.E. (1979). Orbital hemorrhage.Am J Ophthalmol; 88(2):254-258.13. Todd, B.J., Sullivan, T.J., and Gole, G.A. (2001). Delayedorbital hemorrhage after routine strabismus surgery.Am J Ophthalmol; 131(6):818-819.14. Warburton, G. and Brahim, J. (2006). Intraorbitalhematoma after removal of upper third molar: A case report.J Oral Maxillofac Surg; 64(4):700-704.15. Butler (2006). Penetrating Injury to the Orbit. NOM-LLC Case Report 0601; 29 Nov 2006.16. Lewis, C.D. and Perry, J.D. (2007). Retrobulbar hemorrhage.Expert Rev Ophthalmol; 2(4):557.17. Zachariades, N., Papavassilious, D., and Christopoulos,P. (1996). Blindness after facial trauma. Oral Surg OralMed Oral Pathol Oral Radiol Endod; 81(1):34-37.18. Ansari, M.H. (2005). Blindness after facial fractures: A19-year retroscpective study. J Oral Maxillofac Surg;63(2):229-237.19. Burns, G.D. and DeLellis, S.M. (2007). Lateral canthotomyin orbital compartment syndrome: Special Operationsmedics on the battlefield can save the eye. J SpecialOperations Medicine; 7(3):33-36.20. Bailey, W.K., Paul, C., and Evans, L.S. (1993). Diagnosisand treatment of retrobulbar haemorrhage. J OralMaxillofac Surg; 51:780-781.21. Peak, D.A. (2007). Acute orbital compartment syndrome.eMedicine Journal (Serial Online). RetrievedJuly 5, 2009 from emedicine.com website. Website:http://www.emedicine.com/emerg/topic881.htm.22. McInnes, G. and Howes, D.W. (2002). Lateral canthotomyand cantholysis: A simple, vision-saving procedure.Can J Emerg Med; 4(1):49-52.23. Vassallo, S., et al. (2002). Traumatic retrobulbar hemorrhage:Emergent decompression by lateral canthotomyand cantholysis. J Emerg Med; 22(3):251-256.24. Carrim, Z.I., Anderson, I.W.R., and Kyle, P.M. (2007).Traumatic orbital compartment syndrome: Importance ofprompt recognition and management. European J EmergMed; 14(3):174-176.25. Gerbino, G., Ramien, G.A., and Nasi, A. (2005). Diagnosisand treatment of retrobulbar haematomas followingblunt orbital trauma: A description of eight cases. Int JOral Maxillofac Surg; 34:127-131.26. Harrahill, M. (2006). A case report of traumatic eyecompartment syndrome. J Emergency Nursing; 1:104-105.27. Saussez, S., et al. (1998). Lateral canthotomy: A simpleand safe procedure for orbital haemorrhage secondary toendoscopic sinus surgery. Rhinology; 36(1):37-39.28. Katz, B., Herschler, J., and Brick, D.C. (1983). Orbitalhaemorrhage and prolonged blindness: A treatable posterioroptic neuropathy. Br J Ophthalmol; 67(8):549-553.29. Heyreh, S.S. and Jonas, J.B. (2000). Optic disk and retinalnerve fiber layer damage after transient central retinalartery occlusion: An experimental study in Rhesusmonkeys. Am J Ophthalmol; 129(6):786-795.30. Goodall, K.L., et al. (1999). Lateral canthotomy and inferiorcantholysis: An effective method of urgent orbitcaldecompression for sight threatening acute retrobulbarhaemorrhage. Injury; 3(7):385-390.31. Benton, M.D. (2004). The use of emergent lateral canthotomyto restore vision (letter). Am Fam Physician;69(9).32. Perry, M., et al. (2005). Emergency care in facial trauma:A maxillofacial and ophthalmic perspective. Injury;36:875-896.30Journal of Special Operations Medicine Volume 9, Edition 3 / Summer 09
33. Rosdeutscher, J.D. and Stradelmann, W.K. (1998). Diagnosisand treatment of retrobulbar haemorrhage resultingfrom blunt periorbtial trauma. Ann Plast Surg;41:618-622.34. Iwamoto, M.A. and Iliff, N.T. (1998). Management oforbital trauma. In T.W. and E.A. Jaeger, Ed. Duane’sClinical Ophthalmology. Philadelphia, LippincottWilliams & Wilkins. 1998, Chapter 87, p 1-4.35. Rhee, D.J. and Pyfer, M.F. (2002). Traumatic retrobulbarhemorrhage. In D.J. Rhee and M.F. Pyfer Ed. TheWills Eye Manual. Office and emergency room diagnosisand treatment of eye disease. Philadelphia, LippincottWilliams & Wilkins. 2002, p. 41-44.36. Han, J.K., et al. (2008). Management of retrobulbarhematoma. Am J Rhinol; 22(5):522-524.37. McIlwaine, G.G., Fielder, A.R., and Brittain, G.P. (1989).Spontaneous recovery of vision following an orbitalhaemorrhage. Br J Ophthalmol; 73:926-927.38. Wood, C.M. (1989). The medical management of retrobulbarhaemorrhage complicating facial fractures: A casereport. Br J Oral Maxillofacial Surg; 27:291-295.39. Prodhan, P., et al. (2003). Orbital compartment syndromemimicking cerebral herniation in a 12-year-oldboy with severe traumatic asphyxia. Ped Crit Care Med;4(3):367-369.40. Markovits, A.S. (1977). Evacuation of orbital hematomaby continuous suction. Ann Ophthalmol; 9(10):1255-1258.41. Liu, D. (1993). A simplified technique of orbital decompressionfor severe retrobulbar hemorrhage. Am JOphthalmol; 116(1):34-37.42. Markovits, A.S. (1994). A simplified technique of orbitaldecompression for severe retrobulbar hemorrhage(Letter to the Editor). Am J Ophthalmol; 117(1):124.43. Friedberg, M.A. and Rapuano, C.J. (1990). Traumaticretrobulbar hemorrhage. In M.A Friedberg and C.J. RapuanoEd. Wills Eye Hospital office and emergency roomdiagnosis and treatment of eye disease. Philadelphia, J.B.Lippincott company. P. 36-38.44. Liu, L. and Hackett, T.S. (2006). Lateral orbital canthotomy.eMedicine Journal (Serial Online). Retrieved July5, 2009 from emedicine.com website. Website:http://www.emedicine.com/proc/topic82812.htm.45. Suner, S., Simmons, W., and Savitt, D.L. (2000). Aporcine model for instruction of lateral canthotomy. AcadEmerg Med; 7(7):837-838.46. Wadman MC. (2007). Emergency Procedures Laboratory.University of Nebraska Medical Center. EmergencyMedical Education. Retrieved July 6, 2009 from Universityof Nebraska Medical Center website. Website:http://www.unmc.edu/dept/emergency/education/index.cfm?L2_ID=34&L1_ID=2&L3_ID=33&CONREF=2847. Sanchez, L.S., et al. (2006). Procedure lab used to improveconfidence in the performance of rarely performedprocedures. Eur J Emerg Med; 13(1):29-31.CPT Steven Roy Ballard graduated from Brigham Young University with a BS in Finance and Zoologyin 2000. He received his commission to the Army in 2001 and completed his medical degreefrom Uniformed Services University in 2005. Upon completion of a transitional internship at EisenhowerArmy Medical Center in 2006 he was assigned to Fort Carson, CO, as a GMO where he wasprivileged to care for the 2nd Brigade Combat Team rear detachment during their deployment toIraq. He is currently engaged in his final year of ophthalmology residency training at the Universityof Tennessee in Memphis, and will return to military service in 2010.Robert W. Enzenauer, MD is currently professor of ophthalmology and Chief of Ophthalmology at theChildren's Hospital in Aurora, CO. Dr. Enzenauer is board certified in ophthalmology, preventivemedicine (aerospace medicine), and pediatrics. With over 35 years of uniformed service on activeduty and in the Army National Guard, for the past decade COL Enzenauer has served as a Senior FlightSurgeon and the Battalion Surgeon of the 5/19th SFG(A), Colorado Army National Guard. He deployedto Afghanistan 2002-2003 during OEF and to Iraq 2003-2004 during OIF.Thomas J. O’Donnell, MD, Col, USAF, MC (Ret) earned his undergraduate degree at the University ofTennessee, Knoxville, and his medical degree at the University of Tennessee Health Science Center inMemphis (UTHSC). He served as a Naval flight surgeon and then completed an ophthalmology residencyat UTHSC. He retired from the U.S. Air Force after serving 22 years of active duty including toursas an ophthalmologist, Chief of the Medical Staff, and squadron commander. He completed a neuroophthalmologyfellowship at Duke University Medical Center, and is currently Director of the Neuro-Ophthalmology and Low Vision services at the Hamilton Eye Institute, UTHSC.Emergency Lateral Canthotomy and Cantholysis: A Simple Procedure to Preserve Vision fromSight Threatening Orbital Hemorrhage31
Page 1 and 2: Volume 9, Edition 3 / Summer 09 Jou
Page 3 and 4: An 18D deworms a camel during a “
Page 5 and 6: Field Evaluation and Management of
Page 7 and 8: The circumferential anchoring strip
Page 9 and 10: In doing so, all the skin is closed
Page 11 and 12: NATO SOF Transformation and theDeve
Page 13 and 14: current and future operations, thes
Page 15 and 16: sion of a physician, and limited pr
Page 17 and 18: REFERENCES1. James L. Jones, “A b
Page 19 and 20: This article is the first of two me
Page 21 and 22: Figure 4 : A Special Forces medic c
Page 23 and 24: exposure. Conversely, the customary
Page 25 and 26: 7. Ted Westmoreland. (2006). Attrib
Page 27 and 28: first three days of injury, althoug
Page 29 and 30: 9. Markgraf CG, Clifton GL, Moody M
Page 31 and 32: the only sign of OCS may be elevate
Page 33: E. The canthotomy allows for additi
Page 37 and 38: Tinnitus, a Military Epidemic:Is Hy
Page 39 and 40: The development of chronic NIHL pro
Page 41 and 42: supplied by diffusion. During expos
Page 43 and 44: similar to those of other authors,
Page 45 and 46: promising effect on tinnitus. Howev
Page 47 and 48: ADDITIONAL REFERENCESHoffmann, G; B
Page 49 and 50: et al. demonstrated that both right
Page 51 and 52: TYPICAL CHEST RADIOGRAPH FINDINGS I
Page 53 and 54: 11. Norsk P, Bonde-Petersen F, Warb
Page 55 and 56: ABSTRACTS FROM CURRENT LITERATUREMa
Page 57 and 58: tourniquet times are less than 6 ho
Page 59 and 60: tal from July 1999 to June 2002. In
Page 61 and 62: Operation Sadbhavana: Winning Heart
Page 63 and 64: CENTRAL RETINAL VEIN OCCLUSION IN A
Page 65 and 66: of the X chromosome. Notable is tha
Page 67 and 68: AUTHORS*75th Ranger Regiment6420 Da
Page 69 and 70: Casualties presenting in overt shoc
Page 71 and 72: PSYCHOLOGICAL RESILIENCE AND POSTDE
Page 73 and 74: spondents without PTSD (M = 4.6, SD
Page 75 and 76: patients, whereas the mean score of
Page 77 and 78: 29. Whealin JM, Ruzek JI, Southwick
Page 79 and 80: average, time between return from d
Page 81 and 82: ing functioning in both PTSD (Zatzi
Page 83 and 84: Editorial Comment on “Psychologic
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Blackburn’s HeadhuntersPhilip Har
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The Battle of Mogadishu:Firsthand A
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Task Force Ranger encountered enemy
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Peter J. Benson, MDCOL, USACommand
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Numerous military and civilian gove
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Anthony M. Griffay, MDCAPT, USNComm
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This is a great read that speaks di
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and twenty-eight. Rabies immune glo
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Rhett Wallace MD FAAFPLTC MC SFS DM
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LTC Craig A. Myatt, Ph.D., HQ USSOC
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LTC Bill Bosworth, DVM, USSOCOM Vet
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Europe, Mideast, Africa and SWAU.S.
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SOF and SOF Medicine Book ListWe ha
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TITLE AUTHOR ISBNCohesion, the Key
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TITLE AUTHOR ISBNI Acted from Princ
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TITLE AUTHOR ISBNRats, Lice, & Hist
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TITLE AUTHOR ISBNThe Healer’s Roa
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TITLE AUTHOR ISBNGuerilla warfare N
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TITLEAUTHORBlack Eagles(Fiction)Bla
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TITLE(Good section on Merrill’s M
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GENERAL REFERENCESALERTS & THREATSB
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Aviation Medicine Resources: http:/
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LABORATORYClinical Lab Science Reso
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A 11 year old boy whose tibia conti
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Meet Your JSOM StaffEXECUTIVE EDITO
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Special Forces Aidman's PledgeAs a
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