40. Lateral Canthotomy Revisited: A Refined Surgical Approach for Orbital Access

PURPOSE: Lateral canthotomy is a surgical technique which may broaden access to the lateral orbit and orbital floor. Despite the benefits of this maneuver, it has also been reported to lead to unpredictable healing and possible negative sequelae, such as rounding of the lateral canthal angle, entropion, and visible scar. We evaluate a less common modification to lateral canthotomy that aims to minimize complications while improving surgical access. METHODS: Lateral canthotomy was performed through a vertically-oriented incision made 2-3 mm medial to the lateral canthal angle along the lower lid. By this approach, only the inferior crus of the lateral canthal tendon was divided. A retrospective chart review was performed of patients with orbital floor fractures who underwent reconstruction using a transconjunctival incision and lateral canthotomy as described. Postoperative clinical documentation was evaluated on serial outpatient follow-up to assess for aesthetic and functional complications. RESULTS: The senior author performed 47 orbital floor repairs using a transconjunctival approach with lateral canthotomy. The average patient was 35.2 years of age (range, 4 - 75), and followed for 20.7 weeks (range, 0.4 - 132.1). The overall complication rate was 10.6%, consisting of residual enophthalmos 3 (6.4%), blurry vision 1 (2.1%), and infection 1 (2.1%). No patients demonstrated rounding of the lateral canthal angle, ectropion, entropion, or other aesthetic concerns. CONCLUSION: Our retrospective study highlights an uncommon approach for lateral canthotomy which minimizes risks traditionally associated with this surgical maneuver, while still affording the same degree of surgical exposure as the classical method.