The swinging upper eyelid approach for large encapsulated intraconal masses presenting superolateral to the optic nerve (U-Swing)

Abstract

ABSTRACT Purpose To describe an upper eyelid swinging approach (U-Swing) that is suitable for the surgical excision of a large benign encapsulated lesions located in the intraconal space superolateral to the optic nerve. Methods This is a retrospective case series. The study included a review of five patients’ records who had large encapsulated intraconal masses, superolateral to the optic nerve, and who underwent surgical excision with the U-Swing approach in the authors’ institute over the last 10 years. This approach entailed a planned upper temporal fornix-based conjunctival flap and a lateral canthotomy. Preoperative radiological investigations, pre- and post-operative vision testing, and photographs were presented with at least 6 months follow-up. Results All patients within the 1st postoperative month had minimal postoperative edema, minimal conjunctival redness, no visible conjunctival or skin scar, normal pupil size and pupil reaction, full extra ocular motility, recovered upper eyelid position and excursion. Conclusions The U-Swing approach provides a horizontally expandable surgical window that allows safe removal of a large, encapsulated intraconal mass, superolateral to the optic nerve with low morbidity and rapid recovery.