Caruncular Recruitment in Medial Canthal Tendon Repair

Ular Recruitment in medial canthal tendon repair, authored by Alan Wilk, Craig Si and Jill Foster, lower eyelid medial ectropion and medial canthal laxity present surgical challenges in the aging eyelid. Most common lower eyelid tightening procedures rely on lateral repositioning because the lacrimal drainage system interferes with access to the medial canal tendon. This video demonstrates a basic technique to tighten the tendon and improve punctal aversion while preserving the lacrimal system. A foal silk frost suture is placed in the lower eyelid to assist in exposure and retraction. The eyelid is diverted over a cotton swab and the conjunctival incision is marked with a skin marking pen and outlined with a cautery tip for hemostasis. The conjunctiva and lower eyelid retractors are removed with a curved diver scissors. The vertical height of the excision is approximately five millimeters and the horizontal length is about 12 millimeters. The band of conjunctival removal extends up to the base of the Caron. Additional ular mucosa is trimmed to reach the firm bed of the Carle when using a single armed four vicral suture. The suture is passed from the external skin through the post orbicular fascial plane to the lateral base of the elliptical excision. The suture is then passed in a purse string fashion around the surgical ellipse. When the suture pass reaches the nasal end of the ellipse, a purposeful bite of the carle is taken. The upper portion of the ellipse is grasped by the suture and then the suture is externalized out to the skin exiting near the original entry site. The Vicryl is tied and cut. Six oh plain gut is used in a buried fashion. To close the conjunctival incision, the retraction suture is removed. Note the improved position of the lower puncta postoperatively. The patient uses antibiotic ointment to prevent irritation and infection. We hope you find this technique helpful for treating punctal aversion and medial canthal tendon laxity.