Lower eyelid complications associated with transconjunctival versus subciliary approaches to orbital floor fractures

Subciliary and transconjunctival approaches are commonly used to enter the orbital floor. Although both surgical approaches have been used for decades, there is no consensus regarding the most appropriate incision to prevent postoperative lower eyelid complications. The aim of this study was to compare the frequencies of lower eyelid complications after subciliary versus transconjunctival approaches to orbital floor fractures. The investigator implemented a retrospective cohort study and enrolled a sample consisting of subjects who had orbital floor repair. The predictor variable was two different surgical methods, subciliary or transconjunctival approch. The primary outcome variable was postoperative lower eyelid complications (ectropion, entropion, and eyelid retraction). Other variables were demographic backgrounds, anatomical consideration, or time to surgery. The samples were composed of 346 patients (98 [28.3%] females; 225 [65%] underwent a subciliary approach) with a mean age of 42.7 ± 21.1 years. The subciliary approach was significantly linked to the higher rates of ectropion and the lower rates of entropion at 7 days and 6 months postoperatively. There was no statistically significant difference in the frequency of eyelid retraction between both groups. In the setting of orbital floor fractures, these results suggest that the use of the subciliary approach increases the frequency of ectropion, while the transconjunctival approach increases the frequency of entropion. Consequently, the selection should be based on an individual patient basis and surgeon’s preference