A full thickness encircling
incision approximately 2-3mm from the eyelid edges is
made around the palpebral fissure with a scalpel blade,
and the eyelids may be grasped with Allis tissue forceps on
either side in order to provide easier manipulation. Allis
tissue forceps alone, without suturing the eyelid margins,
may provide satisfactory traction. Blunt dissection is carried
out as far as the orbital margin and sectioning of the lateral
and shorter medial canthal ligaments is required. Once the
eyelids are mobile, gentle traction is applied and dissection
is continued caudally outside the extraocular muscles,
taking care not to puncture the conjunctival sac. Attempts
to place a ligature around the optic nerve and associated
blood vessels are made as in the trans-conjunctival method,
although visualisation is not as good. After removing the
globe, the periocular tissue should be carefully dissected
from the sclera before placing it in fixative. Closure is