Canthopexy

Canthopexy is a surgical procedure that tightens or repositions the lateral canthus by anchoring the lateral canthal tendon to the orbital rim or adjacent periosteum. The aim is to reinforce the lateral eyelid support and correct or prevent malpositions such as ectropion (outward turning of the lower lid). It may be performed as a temporary or permanent procedure and is typically carried out by oculoplastic or plastic surgeons.

Indications include involutional or paralytic lower eyelid laxity with ectropion or entropion, lid malposition after trauma or extensive eyelid surgery, and supportive procedures during reconstructive eyelid operations. It is also used to correct lower lid malposition in facial nerve palsy and to stabilize the eyelid after eyelid implants or cheek procedures.

Technique varies, but commonly involves a small lateral canthal incision or through a transconjunctival approach. A non-absorbable suture is placed through the lateral canthal tendon and secured to the periosteum of the lateral orbital rim, Whitnall's suspensory ligament, or adjacent orbital structures to create a tighter, more posterior canthal angle. Temporary canthopexy uses removable sutures, while permanent canthopexy uses durable materials and may be combined with minimal shortening or repositioning of the canthal tendon (canthoplasty).

Outcomes are generally favorable when the procedure is appropriately indicated, offering improved eyelid position and reduced tearing due to exposure. Risks include overcorrection or undercorrection, lid malposition, lid tightening or gap at the canthus, scleral show, infection, bleeding, and scarring. The choice between temporary and permanent approaches depends on the underlying pathology and surgeon preference.