fig1

Figure 1. Demonstration of combined transcaruncular-transconjunctival approach in the right orbit of the cadaver. (A) An incision is made between the caruncle (dashed arrow) and semilunar fold (solid arrow) as each structure is retracted. (B) Spreading dissection is performed towards the posterior lacrimal wall. (C) The globe is retracted laterally and subperiosteal dissection behind the lacrimal bone exposes the medial orbital wall (arrow). (D) A medialized lateral canthotomy is performed by incising the inferior canthal crus. (E) The planned transconjunctival incision is marked along the lower lid (dashed line). (F) The inferior orbital rim (arrow) is exposed following transconjunctival incision and retroseptal dissection. (G) The inferior oblique muscle (arrow) is identified as the globe retracts superiorly. (H) A titanium reinforced porous polyethylene implant is positioned through the combined transcaruncular-transconjunctival incision. (Re-published from Nguyen et al. with permission from SAGE Publishing^[8]).