Transconjunctival medial anterior orbitotomy
If video fails to load, use this link: https://vimeo.com/143470671
This is Richard Allen at the University of Iowa.
This video demonstrates a transconjunctival medial, anterior orbitotomy in a patient with a cystic lesion in the medial orbit.
The patient has a history of previous strabismus surgery and the lesion is thought to be related to this. 4-0 silk sutures are placed through the eyelids medial to provide traction. The lesion is demonstrated. Westcott scissors are used to make an incision through the conjunctiva. With this lesion likely being a cyst, the goal will be to completely excise the cyst without compromising the cyst wall. A combination of blunt and sharp dissection is carried out around the cyst with Westcott scissors. As this lesion is likely related to the patient's previous strabismus surgery, we expect that the lesion may be adherent to the medial rectus muscle. A combination of retraction with the cotton tip applicator on the cyst as well as skin hooks through the conjunctiva provide exposure. I think the cyst wall would be too thin to use a cryo probe. Again, slow, patient dissection on all sides of the cyst until visualization is compromised, then move your dissection to another area. Dissection continues posteriorly until the cyst is mobilized. This cyst was attached to the underlying medial rectus muscle. It was determined that the cyst would be deflated and excised to prevent damaging the medial rectus muscle. Gentle bipolar cautery was then applied to the area of attachment to hopefully eradicate any retained cyst wall to prevent recurrence. The area is inspected and hemostasis is assured. The conjunctiva is closed with 7-0 Vicryl suture. The patient will use antibiotic ointment three times per day and follow up in one week for reevaluation.