University of Iowa Health Care

Ophthalmology and Visual Sciences

Transconjunctival Anterior Orbitotomy for inferior rectus mass

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This is Richard Allen at the University of Iowa.  This video demonstrates an anterior orbitotomy through a transconjunctival and lateral canthotomy/cantholysis incision for a mass that is in the inferior rectus muscle at the level of the posterior aspect of the globe. 

A lateral canthotomy and inferior cantholysis are performed with the monopolar cautery. 

A transconjunctival incision is made inferior to the inferior boarder of the tarsus. 

Dissection is then carried out between the orbicularis muscle and orbital septum to the inferior orbital rim. 

Access to the lesion will be obtained by dissecting the periosteum from the orbital floor an incising the periosteum at the level of the posterior globe. 

The monopolar cautery then incises the periosteum of the inferior orbital rim. 

A Freer periosteal elevator is used to dissect the periosteum from the orbital floor.  This dissection is performed posteriorly to the posterior orbital floor. 

The periosteum is opened at the area of the mass and front biting forceps are used to attain a piece of the area of interest. 

An additional specimen is obtained with the Yasirgil scissors and meringotomy forceps. 

Path evaluation of this mass showed it to be granulomatous inflammation consistent with sarcoidosis, which was confirmed with serologies and a chest CT. 

The transconjunctival incision was then closed with 7-0 Vicryl sutures. 

The canthotomy/cantholysis incision was closed by performing a lateral tarsal strip.

Dissection is performed between the anterior and posterior lamella followed by excision of the mucocutaneous junction of the posterior lamella. 

The strip is then scraped with a 15 blade and shortened with Westcott scissors. 

A double are 4-0 Mersilene suture is placed through the strip followed by engagement of the periosteum at the level of Whitnall's tubercle. 

The canthotomy incision is then closed with the 7-0 Vicryl suture. 

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last updated: 04/27/2015
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