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Medial Canthal Resection

This is the procedure of choice when marked medial canthal tendon laxity is present that results in dystopia of the medial canthal angle at rest.[11] This may be associated with many forms of ectropion but is seen most commonly with involutional changes.

The procedure involves resection of the medial canthal structures combined with horizontal lid shortening. The posterior limb of the medial canthal tendon is reconstructed with a permanent suture, and the cut inferior canaliculus is marsupialized into the conjunctival sac of the lower fornix.[12] This gives good long-term results with relief of epiphora in the majority of patients.

A vertical full-thickness cut is made through the lower lid just lateral to the caruncle to include the canthal tendon and canaliculus (Fig. 12-7-2). The canaliculus is preserved by placing a probe into it prior to the cut and moving the scissors laterally after the initial vertical incision is made. The conjunctival incision is continued …