The principle is that the margin of the upper and lower lids medial to the lacrimal puncta are joined to reduce the palpebral aperture and support the medial end of the lower lid.
The technique is as follows:
• Place lacrimal probes in the canaliculi. Make incisions along the upper and lower lid margins medial to the puncta, staying anterior to the canaliculi, and join the incisions at the inner canthus. Undermine the skin to expose the orbicularis muscle above the below the canaliculi.
• Place one or two 6/0 absorbable sutures from the muscle above the upper canaliculus to the muscle below the lower canaliculus.
• Tie the sutures to approximate the upper and lower lids of the inner canthus.
• Close the skin with 6/0 sutures. Remove the sutures at a week.
Complications - the canthoplasty may stretch with time.
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