Single subciliary/subtarsal incision approach for decompression of the orbit and complex fractures, using the inferior oblique muscle as a safety guide to the medial wall of the orbit: a 25-year experience in 361 cases.

The transconjunctival approach (TCA) is popular to gain access to the walls of the orbit, despite some unfavourable outcomes, such as entropion and damage to the lacrimal apparatus. Access to the medial wall is also challenging because of the position of the inferior oblique muscle (IOM), which can lead to iatrogenic palsy of the IOM and diplopia after its detachment. As an alternative, it is possible to use a subtarsal (STA) or subciliary approach (SCA) to avoid IOM injury. The present paper reports 361 orbits treated through a single SCA or STA for bone decompression and fixation of complex fractures. The IOM has been preserved and used as safety guide to reach the medial wall. From 2000 to 2024, we used SCA/STA to gain access to the floor, lateral, and medial walls of the orbit in 361 procedures involving the medial wall. The IO muscle was not divided in any case and one patient had clinical mild diplopia that lasted about two months. The rate of ectropion was 5.5%, with six cases (1.8%) corrected under local anaesthesia. We report that SCA/STA is a simple, reliable and fast approach to the orbit, preserving the IOM to get the medial wall.