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Use of Cyanoacrylate Glue for Replacing Orbital Bone After Lateral Orbitotomy: A Pilot Study.

To the Editor: First described by Kronlein in 1888, lateral orbitotomy remains an indispensible approach for access to the lateral and superolateral orbital compartment. Although different modifications for this approach have been described, swinging or removing the lateral orbital wall provides wide access to the lateral intraconal and extraconal space. Bone removal apart from providing a wide surgical field exerts lesser pressure and stretch on the optic nerve, thereby decreasing the chances of postoperative visual loss. In the traditional technique, the lateral orbital wall is exposed either by the traditional Stallard–Wright incision, or the sub brow incision, or the swinging eye lid crease incision where the scar gets partially concealed within the eyelid crease. The removed lateral orbital wall after completion of the procedure needs to be replaced with plates and screws or is wired. Placing wires and screws is not only time consuming but is also tedious and complicated. A, External photograph showing application of Cyanoacrylate glue droplets at the bony incision site after the bone being replaced. B, Postoperative CT scan of a patient being operated for left sided pleomorphic adenoma of the lacrimal gland, taken 3 months after surgery. The removed superolateral wall had been replaced with cyanoacrylate glue. The bony margins are smooth without any evidence of malunion or excessive callus formation. which could have been the contributing factor to their ocular irritation. Among preservatives used in antiglaucoma drops, benzalkonium chloride is most commonly associated with adverse reactions. We present these cases to demonstrate the effect of antiglaucoma drops on the Clinical Activity Score of patients with GO and the potential effects regarding management. Patient 1 was believed to have an active flare of GO with increased inflammation. Patient 2 was considering orbital decompression for persistent orbital congestion and exposure keratopathy, which symptomatically resolved after stopping her topical medications. Antiglaucoma medications should be considered as a potential contributing factor in patients with GO and apparent worsening disease activity before proceeding with invasive surgery or systemic therapy for GO. In patients for whom glaucoma drops cannot be changed, a small amount of ocular irritation and inflammation may be tolerated. We recommend monitoring these patients with a glaucoma specialist and considering a trial off drops to differentiate increased activity of GO versus medicamentosa.