The lid crease approach to the superomedial orbit

The lid crease incision of the upper lid allows direct exposure of the orbital septum and levator aponeurosis and can be used to dissect dermoid tumors or any tumor of the middle orbit space from the medial horn of the levator aponeurosis and the tendon of the superior oblique muscle. One advantage of the lid crease incision is its location in the normal eyelid crease, which provides a "front door" approach familiar to the ophthalmic surgeon. Also, the distensibility of the eyelid skin allows for marked retraction of tissues and exposure of large orbital masses well beyond the medial extent of the incision. In addition, the lid crease incision offers significant advantages in completing the dissection of the poorly-defined plane between dermoid tumors and the medial horn of the levator aponeurosis. Finally, with this approach, if there is direct damage to the lid structures, primary repair can be easily accomplished.