AIM: To remove orbital cavernous hemangioma by transconjunctival approach, and to examine efficacy and complications of this approach.

METHODS: We retrospectively analysed 74 patients with orbital cavernous haemangiomas between January 2007 and December 2013. Cavernous hemangioma was diagnosed preoperatively by computed tomography(CT)or magnetic resonance imaging(MRI)combined with color Doppler. Patients were underwent conjunctival approach, tumors located in the inferior, inferior lateral, or inferomedial sector using inferior fornix conjunctival incision, tumors located in super-lateral sector using the lateral conjunctival incision, tumors located in the superior and inferomedial sector using the super-nasal fornix conjunctival incision. Following exposure, the tumor was clamped and slowly pulled out. Careful dissection is necessary in case where tight adhesions are present.

RESULTS: The tumors were confirmed to be cavernous hemangiomas, consistent with preoperative diagnosis in 100%. Intraconal location was found in 58(78%), 16(22%)cases were in extraconal, including 12(16%)cases located in superlateral sector, 16(22%)cases located in superiormedial or superior sector, interior, inferiorlateral, or inferior locations occurred in 46(62%)cases. The tumor was 8mm to 59mm in diameter. All cases were underwent conjunctival approach, including 46 patients underwent inferior fornix conjunctival incision, 12 patients underwent lateral conjunctival incision, the supernasal fornix conjunctival incision was used on 16 cases. Nine patients were resected one third of the tumor firstly, then removed the rest. In 8 patients in visual acuity worsened postoperatively, 6 of them recovered after 6mo. Five patient's visual acuity improved. No patient had any residual proptosis,chemosis was occurred in 10 patients. One patient had unequal pupils as a result of a lesion of the ciliary nerve. Diplopia was spontaneously in all 6 patients in whom ocular movements were limited preoperatively, there was no diplopia in the other 68.

CONCLUSION: The transconjunctival approach of the tumor is suitable for all other than the tumour in the orbital apex, resect the whole tumor in a fractional resection way under orthophoria can effectively reduce the operation risk and improve operation safety.