Step 5 Transconjunctival Incision

Once the lower lid is everted, note the position of the lower tarsal plate through the conjunctiva. Blunt-tipped pointed scissors are used to dissect through the small incision through the conjunctiva made during the lateral canthotomy, inferiorly toward the infraorbital rim. The traction sutures are used to evert the lower eyelid during the dissection. Spread the scissors to clear a pocket just posterior to the orbital septum, ending just posterior to the orbital rim (Fig. 3-8).

Transconjunctival Incision
Figure 3 8 Scissors placed into the initial canthopexy incision to dissect in the subconjunctival plane. The dissection should be just below the tarsal plate and extend no farther medially than the lacrimal punctum. Note how the traction sutures through the lower lid assist in this dissection.

Scissors are used to icise the conjunctiva and lower lid retractors midway between the inferior margin of the tarsal plate and the inferior conjunctival fornix (Figs. 3-9 and 3-10). The incision should not extend farther medially than the lacrimal punctum. A traction suture through the cut edge of the bulbar conjunctiva can be placed to assist in retraction and to hold the corneal shield in place (Fig. 3-11).

Scissors are used to icise the conjunctiva and lower lid retractors midway between the inferior margin of the tarsal plate and the inferior conjunctival fornix (Figs. 3-9 and 3-10). The incision should not extend farther medially than the lacrimal punctum. A traction suture through the cut edge of the bulbar conjunctiva can be placed to assist in retraction and to hold the corneal shield in place (Fig. 3-11).

Figure 3 9 Incision of the conjunctiva below the tarsal plate.
Tarsal Plate Eyelid Anatomy

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