Transconjunctival and Transcaruncular Approaches to the Orbit

Transcaruncular and transconjunctival approaches are commonly used by ophthalmic plastic surgeons to access various orbital compartments. These approaches are versatile and may be combined with transnasal or transcranial approaches to the orbit to gain optimal access to challenging locations. A major advantage of the transcaruncular and transconjunctival approaches is the lack of a visible skin incision with excellent postoperative cosmesis. As with all orbital surgery, an in-depth knowledge of orbital anatomy and physiology, as well as meticulous hemostasis, is needed to prevent complications including globe injury, permanent vision loss, diplopia, and retrobulbar hemorrhage. This article reviews the surgical steps of these approaches. The indications for each approach and case examples are illustrated.