Surgical approach to the medial retrobulbar space

To expose the medial retrobulbar space, an incision is made across the entire brow from the level of the lateral canthal ligament into the medial canthal area. The periosteum is incised and separated from the roof and medial wall to the level of the posterior ethmoidal foramen. The orbital tissues may then be brought forward and downward, making the area more accessible. Damage to the trochlea and levator palpebrae superioris muscle may be avoided by separation of the periorbita and careful handling of the tissues. This approach permitted the removal of a cavernous hemangioma in a 69-year-old woman. The only postoperative complication was supraorbital nerve anesthesia.