Medial lid-split anterior orbitotomy
This is Richard Allen at the University of Iowa. This video demonstrates the use of an upper eyelid split incision to access the superior medial intraconal space.
This approach can be used or an upper lid crease incision, as demonstrated in the optic nerve sheath fenestration video, can be used.
A 15 blade is used to make a full thickness incision along the junction of the medial one-third and lateral two thirds of the eyelid.
4-0 silk sutures are placed at the edges of the incision in order to provide retraction during the case.
Dissection is then carried out within the Tenon's layer. This can be performed bluntly with malleable retractors until the orbital fat is exposed.
This approach can very useful those larger intraconal lesion that are located in the superior medial space.
Additional 4-0 silk sutures can be placed through the edges of the incision in order to provide additional traction.
This allows direct exposure to the superior medial intraconal space.
It is useful to employ an operating microscope once the area of the lesion is encountered.
Closure of the incision can be performed similar to repair of wedge resection or full thickness lid margin incision.