Transconjunctival approach to resection of lower eyelid herniated orbital fat

Abstract

The transconjunctival approach to removal of herniated orbital fat is the method of choice in patients with no evidence of dermatochalasis or hypertrophic orbicularis muscle. This technique has advantages in patients who have undergone previous blepharoplasty and is particularly appropriate in younger patients with good lid tone and favorable lid position. In cases in which horizontal lower lid laxity is present the transconjunctival procedure can easily be combined with horizontal lid tightening through a tarsal strip procedure. Because the external lamellae are not manipulated, eyelid retraction or ectropion is uncommon after this approach. subcutaneously into the center of the upper lid. The upper lid is retracted upward by a silk traction suture placed through skin, orbicularis muscle, and superficial tarsus. An incision is made in the inferior palpebral conjunctiva, midway between the inferior tarsal border and the inferior fornix, between the temporal and medial ends of the eyelid, using a disposable eye cautery (Fig 1). The lower edge of the divided conjunctiva is retracted downward by the surgeon, while the assistant retracts the adjacent superior edge upward and outward with forceps. Dissection through the underlying Muller's muscle and capsulopalpebral fascia is performed with a disposable