Purpose of review: The anterior lid crease approach to the orbit allows the surgeon access to the superior orbital compartments through an upper eyelid incision giving excellent exposure with minimal damage to normal structures. Because the incision is in the lid crease, scarring is minimal. This route into the orbit has gained popularity in recent years and has been used by multiple different surgical subspecialties.
Recent findings: Historically, the eyelid approach to the orbit has been used mainly by ophthalmic plastic surgeons for removal of intraconal and extraconal orbital tumors, orbital fracture repair and optic nerve sheath fenestration. In recent years, other surgical subspecialties have adopted this technique for surgical access to adjacent structures such as the skull base and frontal sinuses. In addition, adjunctive devices, such as the endoscope, are being employed along with the eyelid crease incision to further improve surgical outcomes by decreasing wound size and increasing visualization of the orbital anatomy.
Summary: The use of upper eyelid crease for access to the orbit allows excellent surgical exposure to the superior orbit and adjacent structures with outstanding cosmetic outcome.