Surgical Approaches to the Orbit

Previously considered a neurosurgical field, the management of orbital disease is now an ophthalmic speciality that employs more refined and aesthetic approaches with lower morbidity. With six basic approaches to the orbit, all of which respect the periocular aesthetics, it is generally possible to deal with all solely orbital disease, there being little or no contemporary indication for other approaches—such as a lid-split orbitotomy or bicoronal flap—in such cases. These key approaches include (1) upper lid skin crease, (2) swinging lower eyelid flap (with “high” and “low” variants), (3) lateral canthotomy, (4) lateral orbitotomy with bone mobilisation, (5) transconjunctival retrocaruncular approach, and (6) transconjunctival peritomy. However, where the disease spreads outside the orbit into the cranium, paranasal sinuses, or pterygopalatine fossa, a multidisciplinary approach with neurosurgeons, maxillo-facial or head-and-neck surgeons is best.