Primary and secondary orbit surgery: the transconjunctival approach

Area of Science:

• Ophthalmology
• Plastic Surgery
• Orbital Surgery

Background:

• Transconjunctival orbital surgery is underutilized due to concerns about exposure and eyelid complications.
• Ectropion and eyelid shortening are significant postoperative concerns with this approach.

Purpose of the Study:

• To evaluate the safety and efficacy of the transconjunctival approach for orbital surgery.
• To assess the incidence of lower eyelid ectropion following transconjunctival orbital procedures.

Main Methods:

• A retrospective study of 35 patients undergoing 45 transconjunctival orbital surgeries between 1990 and 1996.
• Exclusion of patients who had transconjunctival blepharoplasty; lateral canthotomy/cantholysis was not performed.
• Categorization of surgeries into fracture plating, bone grafting, and orbital decompression.

Main Results:

• Overall ectropion incidence was 6.7% (3 of 45), with 4% persistent ectropion requiring correction.
• Ectropion exclusively occurred in lower eyelids with prior transcutaneous incisions (17%), not in primary or prior transconjunctival cases.
• No lateral canthotomy or cantholysis was performed during these procedures.

Conclusions:

• The transconjunctival approach offers safe orbital access, particularly in patients without prior transcutaneous incisions.
• This technique can be utilized effectively without lateral canthotomy or cantholysis, minimizing ectropion risk in primary cases.
• Concerns regarding ectropion may be mitigated by careful patient selection, avoiding the transconjunctival approach in revision cases with prior transcutaneous incisions.