The transconjunctival approach for orbital bony surgery: in which cases should it be used?

The advantages and disadvantages of the transconjunctival approach were examined to determine its indication for orbital bony surgery. The transconjunctival approach was used in 22 patients. The average follow-up was 13 months. Two patients had an intraoperative lower eyelid laceration because of excessive traction. Lower eyelid retraction occurred in 5 patients after surgery, although only 1 of them required surgical repair. With a transconjunctival approach alone, the exposure of the orbital lateral wall is limited and incorporation of a lateral incision has been found to be necessary. Postoperative eyelid retraction seems to occur even in the transconjunctival approach. The transconjunctival approach is best indicated in cases with an orbital medial wall fracture because it provides much easier access than any cutaneous approach.