Fig. 33. A. Patient with left-sided proptosis caused by large, well-encapsulated intraconal mass (B). C. Canthotomy and inferior cantholysis allow disinsertion of the lower lid from the lateral orbital rim. D. A subtarsal incision with iris scissors is used to disinsert conjunctiva and lower lid retractors from the inferior border of the tarsal plate. E. Dissection is then carried through orbital septum to expose and remove the large cavernous hemangioma. F. Closure is by simply reapproximating the conjunctiva to the inferior border of the tarsal plate and reattaching the inferior crus to the superior crus of the lateral canthal tendon. G. Postoperative appearance shows excellent scar camouflage afforded by the transconjunctival approach. |