✓Surgical approaches to treat orbital disease should provide a good exposure of intraorbital anatomical structures, allow their functional preservation, and provide good cosmetic results. The authors describe a minimally invasive, combined transconjunctival–eyebrow approach to all orbital quadrants in a step-wise manner. The indications, advantages, and limitations of the technique are highlighted. A transconjunctival approach via the postseptal area is described. It allows exposure of the medial, inferior, and lateral parts of the orbit. Depending on the orbital space to be exposed, a lateral or a medial eyebrow incision is then made. The eyebrow and the conjunctival incisions are connected by subperiosteal dissection. This combined access provides exposure to all intraconal muscles and to the superior, medial, lateral, and inferior portions of the optic nerve. The combined transconjunctival–eyebrow approach provides an excellent orbital exposure, with minimal damage to the circumjacent structures. It requires less operative time than other approaches and yields good cosmetic results. Intracranial or intrafacial tumor extension and tumors located purely in the orbital apex are limitations for the use of this technique.

The rarity of eyelid Merkel cell carcinoma and the fact that it can simulate benign entities frequently lead to difficulties in diagnosis and a delay in the establishment of suitable therapy.

No abstract

HE orbit is a small compartment containing very delicate structures that are essential for the function of vision. Approaches to treat orbital diseases should provide a good exposure of anatomical structures and allow preservation of their function, such as ocular motility and visual acuity. Additionally, in the cases of exophthalmos or ocular deviation, surgery should maintain or improve a patient's physiognomical appearance. Several approaches to the intraorbital space have been described in the literature. 3,5,8,12 Most require bone removal through orbitotomies and/or craniotomies. More recently, transconjunctival approaches have been reported as suitable for the removal of tumors located in the inferomedial, basal, and lateral region of the orbit. 4,7 Moreover, they preclude the need for bone resection and subsequent reconstruction, offering less extensive and traumatic approaches. 4