"Trauma to the Eye"-A Low Fidelity Resident Teaching Module for Identifying and Treating a Retrobulbar Hematoma

Abstract

Introduction: A retrobulbar hematoma (RH) is a serious time-dependent diagnosis due to its potential for permanent damage of the optic nerve, resulting in blindness. Emergency medicine (EM) physicians face the challenge of recognizing this time-sensitive injury and treating it before irreversible damage occurs. Due to its relative infrequency in the emergency department, residents may not have adequate experience in recognizing and treating RH. Methods: This educational intervention outlined a simulated scenario that we developed to educate EM residents to diagnose RH and perform an emergent lateral canthotomy and cantholysis (LCC). Participating residents were asked to obtain a history and perform a physical examination that was consistent with a 34-year-old patient presenting with pushing behind the eye suggesting RH. Once residents made a diagnosis, they practiced performing an emergent LCC on a low-fidelity task trainer supplemented with a novel checklist. The residents completed an assessment questionnaire before and after the teaching module to measure the educational intervention's effectiveness. Results: Learners' scores significantly improved in the ability to recognize and treat RH (12%, p < .001), in confidence in performing the procedure (18%, p < .001), but did not significantly decrease in stress (-10%, p = .058). The intervention was effective in improving preparedness, with all participants indicating that they felt more prepared to treat RH compared to before the educational intervention. Discussion: This educational intervention is a successful resource that can decrease cases of preventable blindness by improving EM residents' ability to recognize and treat RHs.