A randomized comparison of four incisions for orbital fractures

We previously compared conjunctival and subciliary incisions for exposure of orbital floor and infraorbital rim fractures. A prospective randomized comparison of lower eyelid and orbital rim incisions was then undertaken and results compared with our previous study. Lower eyelid and orbital rim incisions provided more rapid access to fracture sites. Fracture exposure was adequate with all but conjunctival incisions; lateral canthotomy was added in 56 percent of cases to improve exposure. There were minimal or no intraoperative and postoperative complications except for a 42 percent incidence of ectropion following subciliary incisions. Scar appearance was similar in the four groups, except when an isolated conjunctival incision was used, which produced an invisible scar.