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 tendon (MCT), using a transcaruncular medial orbitotomy (TMO) approach, is described in a stepwise fashion. The technique described is a modified version of procedures published by Ritleng, Crawford and Collin, and Fante and Elner. Methods: A prospective clinical evaluation of MCT stabilization via the TMO approach was undertaken in II consecutive patients who presented with MCT laxity as one of the features of their ectropion. These cases are initially described in detail in two representative case reports, and summarized in II cases. The stepwise surgical approach is outlined. Results: All patients had improved symptomatology in terms of epiphora and comfort. Furthermore, in all cases the lid position was improved or normalized. In four of the II cases (36%) the lower punctum did not ultimately reside in the lacrimal lake, but the punctal position was nevertheless improved 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 not require canalicular resection, and avoids continued anterior displacement of the medial lower lid which may occur when only the anterior limb of the MCT is addressed surgically.