The transconjunctival approach is preferred in many cases due to favorable cosmetic outcome. Biopsy or excision of lesions in the inferior orbit.Other indications for this approach include: The transconjunctival approach is one of the most commonly used approaches for orbital floor fracture repair and correction of enophthalmos. Buried 6-0 gut suture can be used for closure the conjunctiva.įigure 1: Transconjuctival approach to the orbital floor depicting the (a) the initial incision, (b) dissection of the arcus marginalis, and (c) fracture exposed. ĥ-0 Vicryl suture can be used for closure of the periosteum. Protection and movement of the globe can be performed using malleable retractors. As the septum is opened medially, care should be taken to identify the inferior oblique muscle, whose origin is posterior to the inferomedial orbital rim. If the decision is made to open the septum, the lateral orbital septum can be opened using monopolar cautery or Wescott scissors. At this juncture, the decision can be made whether extraperiosteal dissection or preperiosteal dissection is needed. The inferior palpebral conjunctiva is secured using another traction suture and blunt dissection is carried in the preseptal plane towards the orbital rim. Next, an incision is made through the inferior palpebral conjunctiva using either a scalpel or needle-point monopolar cautery 1-2mm below the border of the tarsus. To begin, a traction suture is placed through the lower eyelid margin. 3 Approaches to the Lateral Orbit and Superior OrbitĪpproaches to the Inferior Orbit Transconjunctival.
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