Endoscopic Medial Rectus Sling: A Window Into the Intraconal Orbital Apex

Area of Science:

• Ophthalmology
• Neurosurgery
• Endoscopic Surgery

Background:

• Surgical access to the medial orbit, particularly within the orbital muscles, demands high precision to prevent damage to critical structures like the optic nerve.
• Traditional approaches may pose risks to surrounding tissues.

Observation:

• A 72-year-old female presented with vision loss and reduced eye movement, diagnosed with bilateral medial orbital apex masses via CT scan.
• An exclusively endoscopic, endonasal approach was used to biopsy the right orbital apex lesion, involving inferomedial retraction of the medial rectus muscle.

Findings:

• The endonasal endoscopic technique provided excellent access to the medial intraconal space and orbital apex.
• Successful biopsy of the medial orbital apex lesion was achieved with minimal trauma and no damage to the optic nerve.

Implications:

• This modified endoscopic approach offers a safe, minimally invasive alternative for accessing medial intraconal orbital lesions.
• It eliminates the need for external or transconjunctival approaches, reducing patient morbidity.