Transcaruncular medial orbitotomy for stabilization of the posterior limb of the medial canthal tendon

Purpose: A method to stabilize the posterior limb of the medial canthal ten don (MCT), using a transcaruncular medial orbitotomy (TMO) approach, is des cribed in a stepwise fashion. The technique described is a modified version of procedures published by Ritleng, Crawford and Collin, and Fante and Eln er: Methods: A prospective clinical evaluation of MCT stabilization via the TMO approach was undertaken in 11 consecutive patients who presented with MCT laxity as one of the features of their ectropion. These cases are initially described in derail in two representative case reports, and summarized in 11 cases. The stepwise surgical approach is outlined. Results: All patients had improved symptomatology in terms of epiphora and comfort. Furthermore, in ail cases the lid position was improved or normali zed. In four of the 11 cases (36%) the lower punctum did not ultimately res ide in the lacrimal lake, but the punctal position was nevertheless improve d and the MCT was stabilized. Conclusion: The TMO procedure provides both excellent MCT stabilization and adequate placement of the lower lacrimal punctum onto the globe. It does n ot require canalicular resection, and avoids continued anterior displacemen t of the medial lower lid which may occur when only the anterior limb of th e MCT is addressed surgically.