Lateral Canthal Tightening Research Articles

Correction of Cicatricial Lower Eyelid Retraction and Entropion With Combined Scar Release, Hard Palate Graft, and Lateral Canthal Suspension.

This study aimed to evaluate the outcome of a technique-combined scar release, hard palate spacer graft with the recession of the lower eyelid retractors, lateral canthal suspension in the repair of cicatricial lower eyelid retraction, and entropion. Records of 12 patients with cicatricial lower eyelid retraction and entropion who underwent the surgery from January 2019 to August 2021 were reviewed. Surgical techniques include the following procedures: release of scar, hard palate graft with recession of the lower eyelid retractors, and lateral canthal tightening to strengthen the support of the lower eyelid. The follow-up period was at least 12 months. Postoperative outcomes were evaluated by the improvement of lower eyelid retraction, resolution of eyelid entropion, and complications. All patients showed resolution in lower lid entropion, and lower eyelid retraction was significantly improved with a mean elevation of 2.93±0.82mm. None of the patients had severe complications postoperatively, and both ocular surface symptoms and cosmetic appearance were significantly improved. The technique achieves long-term stable outcomes in cicatricial lower lid retraction and entropion repair with a low morbidity rate.

Evidence-Based Medicine: A Graded Approach to Lower Lid Blepharoplasty.

After studying this article, the participant should be able to: 1. Define the anatomy of the lower eyelid tarsoligamentous framework and the related periorbital retaining ligaments, and cite their surgical relevance. 2. Perform a systematic functional and aesthetic evaluation of the lower eyelid focusing on the lid-cheek junction, and clinical tests that predict the need for lateral canthal tightening. 3. Enumerate the different approaches to lower eyelid rejuvenation and discuss their merits/limitations. 4. Describe surgical strategies to blend the lid-cheek junction and tighten the lateral canthal retinaculum. Modern lower lid blepharoplasty requires a thorough understanding of periorbital anatomy, age-related changes of the lid-cheek junction, and the variables controlling lower lid tone and position. The surgical strategies are best used in a graded fashion. The patient with isolated lower lid bags may be treated by transconjunctival fat resection alone. Additional mild skin laxity can be improved with skin pinch or skin-only undermining. Skin resurfacing using chemical peeling or laser can further address fine lines. In these patients with an abnormality of the lid-cheek junction, release of the medial orbicularis oculi muscle and variable amounts of the orbicularis retaining ligament is essential. This is combined with orbital fat resection or repositioning through a transconjunctival or transcutaneous skin-muscle flap. The transcutaneous approach most often necessitates lateral canthal tightening to optimize lid margin control. Generally, the degree of laxity dictates whether a canthopexy or a canthoplasty is most appropriate. Lateral canthal procedures can be applied to patients displaying clinical signs predictive of lid malposition and to those presenting with varying degrees of established lid descent.

The Locking Y Lateral Canthopexy With Osseous Integration: Clinical Experience and Surgical Technique.

To describe a surgical technique to correct lateral canthal tendon disinsertion with a strabismus surgery-inspired locking capture of the tendon complex and osseous integration via drill holes. Retrospective interventional case series including all patients with lateral canthal tendon disinsertion who underwent locking Y lateral canthopexy with drill hole reinforcement by 1 surgeon (D.T.T.) between 2006 and 2011. Outcome measures included resolution of presenting ocular symptoms, improved blink dynamics and lid closure, correction of lagophthalmos and exposure keratopathy, and need for further surgery. A total of 53 lateral canthopexies with osseous integration were performed in 42 patients who fulfilled clinical criteria for lateral canthal tendon disinsertion. The population was biased toward treatment failures; 81% of eyes (43/53) had a history of prior lateral canthal tightening, and of these 30.2% (16/53) had undergone 3 or more procedures. Postoperatively, all eyes demonstrated improved eyelid position and blink mechanics, and 83% (44/53) had subjective resolution of epiphora and ocular irritation. Lagophthalmos was fully corrected in 95% (19/20) of cases, and corneal staining resolved in 88% (14/16). With a mean follow-up period of 24 months, 3.7% of eyes (2/53) required additional lateral canthal tightening. The locking Y lateral canthopexy is an effective and durable method for repositioning the lateral canthal tendon complex to improve blink dynamics, eyelid closure, and cosmesis. Even in a population heavily biased toward treatment failure, clinical results are excellent and the reoperation rate is low.

Lateral Canthal Tendon Disinsertion: Clinical Characteristics and Anatomical Correlates.

To highlight features of lateral canthal tendon disinsertion (LCTD), provide an algorithm for systematic assessment, and describe the anatomic genesis of signs and symptoms. Retrospective case series of consecutive patients with lateral canthal tendon disinsertion, who underwent lateral canthal tendon fixation by a single surgeon (DTT) between 2004 and 2011. One hundred and seventeen eyes in 90 patients underwent lateral canthal tendon fixation. Average age was 69.3 ± 17.9 years. Twenty-three percentage of eyes had undergone lower eyelid blepharoplasty and 52% had undergone lateral canthal tightening; 35% had no previous periocular surgery. Patients with purely involutional lateral canthal tendon disinsertion were significantly older (76.1 ± 7.8 years of age; p < 0.03). Six key features associated with lateral canthal tendon disinsertion were identified. On static evaluation: 1) a blunted or vertically displaced lateral canthal angle; 2) a narrow horizontal fissure with reduced temporal scleral triangle; and 3) pseudo eyelid retraction. On dynamic evaluation with attempted closure: 4) medial and inferior movement of the lateral commissure; 5) incomplete apposition of the eyelid margins in the absence of anterior lamellar shortage; and 6) temporal eyelid imbrication. Improved blink dynamics with manual lateral canthal tendon complex repositioning ("the thumb test") predicted a favorable outcome with surgical tightening in 95.7% of cases. Lateral canthal tendon disinsertion results in altered eyelid fissure symmetry, blink dynamics, and lacrimal pump function. The authors recommend the mnemonic-A.B.C.: for Aperture configuration, Blink dynamics, and eyelid Closure-to structure the examination of all symptomatic patients. Manual restoration of the disinserted lateral canthal tendon with the "thumb test" predicts favorable outcomes with surgical fixation.

Surgical preferences for lateral canthoplasty and canthopexy.

To describe the currently used techniques of lateral canthal tightening and their indications. The treatment of involutional ectropion involves horizontal tightening of the lower eyelid via a lateral canthal resuspension procedure, which can be either a canthopexy or a canthoplasty. The lateral tarsal strip, one of the most common canthoplasty procedures performed today, is a powerful technique, very useful in cases of profound eyelid laxity or ectropion in which horizontal eyelid shortening is necessary to achieve adequate eyelid tightening.For less-severe eyelid laxity, a canthopexy can be performed through either an upper or a lower eyelid incision, in which the suture is passed through the eyelid incision without externalization at the lateral canthal angle. We recently described the lateral canthal resuspension sine canthotomy technique that was slightly more effective than the lateral tarsal strip at decreasing the MRD-2 and lengthened the horizontal palpebral aperture without significantly changing the lateral canthal height. Although the lateral canthal resuspension sine canthotomy technique has advantages for tightening loose lower eyelids in both cosmetic and functional cases, the lateral tarsal strip remains the procedure of choice for severe lid laxity or ectropion.

Correction of Involutional Entropion with Suborbicularis Septal and Lateral Canthal Tightening

Background: Involutional entropion, or infolding of the margin of the eyelid, is a common eyelid malposition affecting the elderly that can lead to significant morbidity when not corrected. It is notable for both functional and cosmetic sequelae. Numerous surgical techniques have been described to correct this defect; however, because of its multifactorial pathophysiology, no single procedure has been entirely satisfactory. In this study, the authors present a simple and effective surgical procedure that addresses the salient pathophysiology and successfully corrects this defect with minimal morbidity or chance of recurrence. Methods: Two hundred fifty-three patients (409 eyelids) with involutional entropion who underwent surgical repair from 1995 to 2004 were analyzed. All patients were symptomatic, ranging in age from 61 to 96 years (115 men and 138 women). All patients underwent lateral canthal lysis, suborbicularis and supraorbicularis undermining, canthoplasty, and lateral muscle suspension with septal tightening. Results: All 409 eyelids with symptomatic involutional entropion were successfully corrected. All patients were satisfied with both the functional and cosmetic outcome and experienced a short recovery time. Objective examination revealed a marked improvement in static and dynamic lower eyelid position and alleviation of the herniated lateral orbital fat. There were no complications or entropion recurrences. Conclusions: Involutional entropion is frequently encountered in the elderly. Ideal treatment addresses horizontal lid laxity, improves vertical support, prevents preseptal orbicularis override, and reinserts the lower lid retractors. With the direct, easily executed and effective surgical procedure presented here, both functional and aesthetic improvements can be obtained. This procedure should be included among the techniques used by every surgeon who treats functional and cosmetic problems in the periocular region.

Correction of Involutional Entropion with Suborbicularis Septal and Lateral Canthal Tightening

Spinelli, Henry M. M.D.; Tabatabai, Nassim B.S., M.D.; Nunn, Donald R. M.D., D.D.S. Author Information

Selection of canthopexy techniques

Dr. Carraway: The types of canthoplasty and canthopexy that we will be considering are tarsal strip procedure, lateral canthal tightening, transposition of the lateral canthal tendon, the dermal-orbicular pennant canthoplasty, and the inferior lateral retinacular canthopexy. Dr. Patipa, what is your indication for use of lateral canthal tightening? James H. Carraway, MD Dr. Patipa When I examine a patient's lower eyelid and midface, looking for laxity of the lateral canthal tendon, I primarily assess mobility of the lateral canthal angle. I will then tighten the lateral canthal tendon as part of the surgical procedure to achieve the desired result. Boaz J. Lissauer, MD Dr. Carraway: Dr. Lissauer, how would you use the tarsal strip procedure? What kind of patients would be appropriate? Dr. Lissauer: I use lateral tarsal strip procedures in patients in whom there is significant lengthening of the tarsoligamentous sling with horizontal lid laxity that clinically presents as frank eyelid malposition or cosmetically presents as a rounding or bowing of the temporal aspect of the lower eyelids. Michael P. Grant, MD, PhD Dr. Carraway: Let us now discuss the dermal-orbicular pennant canthoplasty as described by Marsh Edgerton.1 Dr. Grant, do you use this procedure and, if so, under what circumstances? Dr. Grant: This procedure falls in between lateral canthal tightening procedures, as Dr. Patipa described, and a frank lateral tarsal strip. I would use this procedure where there is laxity at the lateral canthal angle and, perhaps, some lateral lid retraction, but not frank horizontal lid laxity with the more pronounced potential for displacement at the lateral canthal angle. Thus I see this as a compromise procedure, similar to other types of suture suspension procedures, but less aggressive than a lateral canthal tightening procedure. Michael Patipa, MD Dr. Patipa: I would like to clarify that in the …

Correction of Involutional Entropion with Suborbicularis Septal and Lateral Canthal Tightening

Involutional entropion, or infolding of the margin of the eyelid, is a common eyelid malposition affecting the elderly that can lead to significant morbidity when not corrected. It is notable for both functional and cosmetic sequelae. Numerous surgical techniques have been described to correct this defect; however, because of its multifactorial pathophysiology, no single procedure has been entirely satisfactory. In this study, the authors present a simple and effective surgical procedure that addresses the salient pathophysiology and successfully corrects this defect with minimal morbidity or chance of recurrence. Two hundred fifty-three patients (409 eyelids) with involutional entropion who underwent surgical repair from 1995 to 2004 were analyzed. All patients were symptomatic, ranging in age from 61 to 96 years (115 men and 138 women). All patients underwent lateral canthal lysis, suborbicularis and supraorbicularis undermining, canthoplasty, and lateral muscle suspension with septal tightening. All 409 eyelids with symptomatic involutional entropion were successfully corrected. All patients were satisfied with both the functional and cosmetic outcome and experienced a short recovery time. Objective examination revealed a marked improvement in static and dynamic lower eyelid position and alleviation of the herniated lateral orbital fat. There were no complications or entropion recurrences. Involutional entropion is frequently encountered in the elderly. Ideal treatment addresses horizontal lid laxity, improves vertical support, prevents preseptal orbicularis override, and reinserts the lower lid retractors. With the direct, easily executed and effective surgical procedure presented here, both functional and aesthetic improvements can be obtained. This procedure should be included among the techniques used by every surgeon who treats functional and cosmetic problems in the periocular region.

Lateral canthal surgery in the management of epiphora

PURPOSE To assess the functional benefit and cosmetic appearance after lateral canthal surgery in the management of epiphora. PATIENTS AND METHODS A case series of 75 eyelids in 52 patients who underwent lateral canthal tightening procedures for epiphora in the Kent & Sussex Hospital (UK) between January 1997 and February 1999. All surgery was performed on a Day Case basis. Patients had between one and three follow-up appointments and all patients were surveyed by telephone in August 1999. The minimum follow-up was six months. RESULTS All patients demonstrated a successful anatomical result at the time of discharge. Epiphora was cured or greatly reduced in 84% of eyes. Satisfaction with the cosmetic appearance was expressed in 86% of eyes. Transient postoperative tenderness over the lateral orbital rim was the most common complication (63%), in some cases lasting up to eight weeks. CONCLUSIONS Lateral canthal surgery is an effective tool in the management of epiphora, giving good functional and aesthetic results.

Autogenous auricular cartilage grafting for lower eyelid retraction.

The authors discuss the surgical correction of lower eyelid retraction in dysthyroid, socket, and blepharoplasty patients. Sixty-three patients underwent a lateral canthal tightening combined with a vertical lengthening of the posterior lamella using autogenous posterior auricular cartilage. The average follow-up was for 2 years. We propose this combined procedure as the surgery of choice in the treatment of lower eyelid retraction seen in these three groups of patients.

The Use of Room Temperature Vulcanizing Silicone in Anophthalmic Enophthalmos

Room temperature vulcanizing silicone proved to be an excellent alloplastic material for soft tissue augmentation for anophthalmic enophthalmos with a deep superior sulcus syndrome. The soft tissues of ten anophthalmic sockets with deep superior sulci and inadequate socket soft tissue volume underwent volume augmentation with a concomitant lateral canthal tightening operation. Cosmetic results were satisfactory.