Access through a transcaruncular incision to the medial orbit has several advantages over a transcutaneous or "Lynch" incision: there is no risk of cutaneous scar and there is little risk to the lacrimal system. This access if very useful for medial orbital wall decompressions and also drainage of medial subperiosteal abscesses. A minimal closure is performed with 3 interrupted sutures -- some colleagues do not even close it.

Below is a written transcript for this video:

This is Richard Allen at University of Iowa. This video demonstrates transcaruncular access to the medial orbital wall. In this case, traction sutures are placed through the medial portion of the upper and lower lid at the level of the tarsus. The caruncle is then fixated with toothed forceps. An additional forceps grasps the plica. A retrocaruncular incision is then made with Wescott scissors. This incision is made through the conjunctiva and underlying Tenons. The incision is made in the direction of the posterior lacrimal crest. Stevens scissors are then used to bluntly dissect to the medial orbital wall just posterior to the posterior lacrimal crest. A small malleable is then used to expose the periosteum of the medial orbital wall. A small Desmarres retractor is placed to hold the caruncle. A Freer periosteal elevator is then used to make an incision through the periosteum of the medial orbital wall.

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