To the Editor.
—We have found Dr Nerad's1 method of using a single Jaffe2 lid speculum to enhance exposure during levator surgery to be extremely helpful. Dr Nerad noted that the speculum may not provide sufficient retraction or traction necessary during external approaches to the orbital floor.1 This problem may be overcome by using two Jaffe lid specula in tandem, thus providing broad exposure of the entire inferior orbital rim (Fig 1).Another useful modification of the Jaffe lid speculum involves introducing a gentle concavity to the normally straight transverse strut (Fig 2). This allows the speculum to retract more easily and evenly, and with less distortion of the naturally curved upper eyelid tissue planes. Furthermore, heavier tissues are less likely to slip out of the modified speculum, and a smaller incision will accommodate the modified speculum. The speculum may be modified with a heavy padded hemostat.
Khan JA, Kresie RJ. Tandem Jaffe Lid Specula for External Approach to the Orbital Floor. Arch Ophthalmol. 1989;107(6):791-792. doi:10.1001/archopht.1989.01070010813009