While chatting with Prof Pete Shah in Lausanne after his formidable presentation at Hopital Jules-Gonin on 27th of April, we discussed the idea that everybody learning ophthalmic loco-regional anaesthesia should also be old how to perform lateral canthotomy. The idea, you’ll have to admit, is compelling. After all, retrobulbar hemorrhage is THE complication that puts the eye and vision at peril immediately and has to be taken care of ASAP. Yet given the rarity of the complication there’s not a lot of practical experience from wich to draw a learning curve. As far as emergeny management of cranial trauma goes, here also an animal training-model could be used to get a feel for the task before you throw away your nerves when your help is needed.
So we start fiddling with split pig-heads. They are cheap and although the anatomy is not entirely the same, you can get a great feel for this skill, if you inject around 20 ml colloid solution retrobulbarly. You can feel how hard the eye gets and observe conjunctival chemosis and lid edema. If you feel like it, measure the IOP before and after retrobulbar injection. You can easily achieve 50 mm Hg of pressure. Now go ahead, use a solid surgical blade, make a lateral incision starting from the lateral canthus, severs upper from lower eye lid and then cut the lateral tendon folds. With the pig eye you have cut a little deeper but soon enough your liquid will ooze out from the orbital cavity and your Intraocular pressures come down to starting level. How do you feel, sight-saver supreme?
If you feel repulsed by swine-heads or if they are “haram” or “treyf” for you, try sheep, lamb, goat or whatever and let us know of your experience!
