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A combined lateral and medial orbitotomy for exposure of the optic nerve and orbital apex.

A technique for exposure and direct visualization of the optic nerve and medial apex of the orbit is presented. The technique involves an initial lateral orbitotomy or Krönlein procedure followed by a nasal conjunctival peritomy, detachment of the medial rectus muscle, and outward rotation of the globe to expose the optic nerve and apex of the orbit. With relaxing incisions in the conjunctiva, the globe can be rotated approximately 45 degrees with visualization of the optic nerve from its exit from the globe to its disappearance into the origin of the rectus muscles. This technique may be used for exposure of the optic nerve and orbital apex for the optic nerve decompression for chronic papilledema in indicated cases, biopsy of lesions of the orbital apex, or excisional biopsies of tumors of the optic nerve.