The fornix approach to the inferior orbit

Abstract

The fornix or transconjunctival approach to the orbital floor and inferior orbit provides excellent exposure for the surgeon managing orbital fractures. The technique is ideally suited for patients with isolated blowout fractures; however, it can be combined with other surgical incisions to provide wide exposure of the inferior orbit, zygoma, and maxilla for the repair of more complex midfacial fractures. The surgical technique provides excellent access to the inferior orbit for biopsy or excision of orbital tumors and excellent opportunity for surgically augmenting orbits with posttraumatic enophthalmos or enophthalmos associated with anophthalmic sockets. Orbital decompression into the maxillary antrum and ethmoid sinus is easily accomplished through this incision. By avoiding a cutaneous incision in the lower eyelid, one reduces the risk for development of postoperative ectropion. During wound closure, the lower eyelid can be elevated and tightened and the canthal angle can be restored if necessary.