Lateral Approach
A lateral approach to the orbit is used when a lesion is located within the lateral intraconal space, behind the equator of the globe, or in the fossa of the lacrimal gland. In addition, because the orbit is relatively shallower in children than in adults, extensive exposure may be achieved in pediatric patients without the need for bone removal.
The traditional curvilinear incision (see Fig 7-2), which extends from beneath the lateral eyebrow along the zygomatic arch, allows good exposure of the lateral rim but leaves a noticeable scar. It has largely been replaced by approaches through either an upper eyelid crease incision or an extended lateral canthotomy incision. After reflection of the temporalis muscle and the periosteum of the orbit, both approaches allow exposure of the lateral orbital rim and the anterior portion of the zygomatic arch. Dissecting through the periorbita and then the intermuscular septum, either above or below the lateral rectus muscle and posterior to the equator of the globe, provides access to the intraconal retrobulbar space. If a lesion cannot be adequately exposed through a soft tissue lateral incision, an oscillating saw is used to remove the bone of the lateral rim to provide further access (Fig 7-8). This procedure is also known as a marginotomy.
Complete hemostasis is achieved before closure. To help prevent postoperative intraorbital hemorrhage, an external drain may be placed in the deep orbit. The lateral orbital rim is usually repositioned and sutured back into place through predrilled tunnels. Alternatively, rigid fixation with a microplating system can be employed.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.