Transcaruncular approach to the medial orbit and orbital apex

Objective: To present a versatile approach to the medial orbit and orbital apex through the caruncle. Design: Retrospective, noncomparative, case series with description of surgical technique. Participants: Twenty-five consecutive patients underwent orbital surgery by use of a transcaruncular approach. Intervention: Inferior and medial wall fracture repair orbital decompression by means of a transcaruncular or combined transfornix-transcaruncular approach. Main Outcome Measures: The surgical indications and complications were recorded for each patient. Results: Ten patients (10 orbits) underwent combined inferior and medial orbital wall fracture repair through a combined transfornix-transcaruncular approach. In 8 of 10 (80%) orbits, the inferior oblique muscle was disinserted during surgery. Fifteen patients (24 orbits) underwent orbital decompression surgery for dysthyroid orbitopathy, An isolated transcaruncular approach was used in 5 of 24 orbits, and a combined transfornix-transcaruncular approach was used in 19 of 24 orbits. There were no complications related to either approach. Conclusions: Orbital bone removal and fracture reduction may be safely completed through a combined transfornix-transcaruncular approach. The transcaruncular approach provides excellent and safe exposure of the medial orbital wall, and it avoids scarring associated with the Lynch approach, Ophthalmology 2000;107: 1459-1463 (C) 2000 by the American Academy of Ophthalmology.