Transcaruncular approach to the medial orbit and orbital apex

Ophthalmology. 2000 Aug;107(8):1459-63. doi: 10.1016/s0161-6420(00)00241-4.


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 or 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decompression, Surgical
  • Graves Disease / surgery
  • Humans
  • Ophthalmologic Surgical Procedures*
  • Orbit / surgery*
  • Orbital Diseases / surgery*
  • Orbital Fractures / surgery
  • Retrospective Studies