Table 3. Surgical approaches in orbital trauma.

Approach (Inferior orbit)	Advantages	Disadvantages
Transcutaneous (midlid, subciliary)	Superior exposure of inferior rim	Decreased medial wall exposure, ectropion in lax senile lids, visible scarring
Preseptal transconjunctival	No visible scarring, easier approach than the retroseptal transconjunctival approach	Need to compromise the orbital septum to get to the orbital floor
Retroseptal transconjunctival	Transcaruncular extension allows exposure of medial wall superior to medial canthal tendon, less risk of vertical shortening if septum orbitale is untouched. Retrocaruncular is better than transcaruncular and precaruncular, as there is less postoperative lid complications and extension of exposure to inferior conjunctival fornix.26 Best for blowout fracture access	Dissection can be made difficult by herniation of fat pads into your surgical field
Supraorbital	Good exposure of lateral orbital rims, cosmetically favorable result	Disruption of levator aponeurosis or Mueller's muscle can cause ptosis.

Source: Adapted from Ricketts et al.²⁵