Lateral Canthotomy/Cantholysis Performance Gap Analysis and Training Recommendations for Expeditionary Physicians

Area of Science:

• Military Medicine
• Ophthalmology
• Surgical Education

Background:

• Ocular trauma is an increasing concern in modern warfare, often overshadowed by life-threatening injuries.
• Delayed recognition and management of serious eye injuries, including ocular compartment syndrome (OCS), lead to suboptimal outcomes.
• OCS requires rapid diagnosis and intervention via lateral canthotomy/cantholysis (LC/C) to prevent irreversible vision loss within approximately 90 minutes.

Purpose of the Study:

• To assess the baseline proficiency of military physicians and surgeons in performing LC/C procedures.
• To identify performance gaps in recognizing and treating OCS.
• To inform the development of targeted professional development programs.

Main Methods:

• A study involving 60 participants from emergency medicine, general surgery, and ophthalmology.
• Procedural competency assessed using a high-reliability eye trauma simulator under 1:1 expert faculty supervision.
• Competency defined as independent and accurate completion of all procedural and critical components.

Main Results:

• Significant performance differences were observed across the three groups (P < 0.001).
• A linear relationship exists between provider expertise and LC/C procedural performance.
• General surgeons and emergency medicine physicians demonstrated performance gaps, indicating unfamiliarity with OCS management and LC/C techniques.

Conclusions:

• Significant performance deficits in recognizing and treating OCS via LC/C were identified among military physicians and surgeons.
• LC/C procedures are critical sight-saving competencies for deployed clinicians.
• Targeted professional development is essential to close performance gaps for emergency medicine physicians and general surgeons.