Subcaruncular Approach for Medial Eyelid Repair: A Simplified Technique

Introduction: Laxity of the medial canthal tendon (MCT) is commonly encountered in clinical practice. The techniques described in the literature to correct MCT laxity often involve extensive dissection, with potential risk to the lacrimal system. We describe a simple and minimally invasive MCT repair in which the medial eyelid is secured to the anterior central portion of the MCT via a subcaruncular approach without disturbing the normal eyelid position or the lacrimal system. Materials and Methods: A retrospective analysis of 30 patients undergoing MCT repair in all 4 eyelids was performed. Eyelids with moderate to severe MCL laxity were treated by this technique. Results: Patient age ranged between 55 and 90 years, with a mean of 74.2 years. Upper lid distraction ranged from 8–20 mm (mean 13 mm). Lower lid distraction ranged from 14–30 mm (mean 23.4 mm). In 87% of patients, eyelid laxity diminished postoperatively, and 13% had incomplete correction of the laxity with recurrence of symptoms. Recurrence was attributed to sutures pulling through attenuated lax lids and to mechanical eyelid stretching caused by sleeping on the face and/or rubbing the eyes. After reoperation in 3 patients, the lids regained normal position and tone, and symptomatic improvement was noted. No patients had postoperative complications involving the lacrimal system with this approach. Conclusions: The described MCT repair technique is an anatomically simple approach for eyelids with moderate to severe MCT laxity; it may be useful for surgeons who otherwise would defer complex repair of the MCT.