title: Appraisal of a modified medial canthal plication for treating laxity of the medial lower eyelid.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy of modified medial canthal tendon plication technique for correcting laxity of the medial end of the lower eyelid.
  
  
  METHODS
  Eleven patients (9 males and 2 females, 21 eyes), with an age range of 31-80 years, having laxity of the medial end of the lower lid of varying degrees were enrolled in this study. These patients presented with complaints of watering, recurrent redness, photophobia and foreign body sensation. After grading the amount of lower lid laxity, plication was performed. In patients in whom laxity was associated with ectropion, the severity of lower lid ectropion was also graded. In patients with ectropion of Grade II or more, additional procedures for its correction were performed before undertaking plication. The patients were followed up 6 months post-operatively and re-assessed for laxity, recurrence of symptoms and complications of plication.
  
  
  RESULTS
  All the lids were evaluated for the amount and extent of laxity of lower lid. Twelve (57%) eyes had Grade I, 9 (43%) had Grade II (and none Grade III) laxity of the lower lid. Twelve eyes had laxity restricted to the medial end and 9 eyes had laxity of the entire length of the lower lid. Some eyes also had an associated ectropion. Among the 21 eyes, 4 eyes (22%) had Grade 1, 11 (61%) had Grade 2, 6 (17%) Grade 3 and none Grade 4 ectropion. In the lids with associated ectropion, additional procedures had been performed. In 1 eye, the medial canthus was anchored to the tendon and this patient had poor apposition of the lower lid to the globe. Hence, in the remaining 20 eyes, the medial canthus was anchored to the orbital periosteum. The mean change in eyelid length was 2.6 mm (measured from medial to lateral canthus) from pre-operative status (33+/-3.4 mm) to the post-operative status (30+/-2.9 mm) this being statistically significant. An overriding of the lower lid was seen in 2 eyes (10%), and a residual gap between the lower lid and globe was noticed in 15 (71%) eyes. Some eyes had uncorrected symptoms including epiphora (3 eyes; 14%), redness (2 eyes; 10%), and photophobia (1 eye; 5%). All were those in which the lateral end was lax. None had a recurrence of foreign body sensation.
  
  
  CONCLUSIONS
  Plication is easy, effective and quick for correcting laxity of the lower lid when restricted predominantly to the medial end. Correct identification of anatomical landmarks and appropriate tension of sutures is vital to achieve proper apposition of the lower lid to the globe.
authors.affiliation: Department of Ophthalmology (Chairman: Dr. P. K. Sodhi), Safdarjung Hospital, New Delhi, India. hardeep333@hotmail.com
authors.forename: Punita Kumari
authors.initials: PK
authors.lastname: Sodhi
authors.forename: Lalit
authors.initials: L
authors.lastname: Verma
authors.forename: Ravindra M
authors.initials: RM
authors.lastname: Pandey
authors.forename: Simmi K
authors.initials: SK
authors.lastname: Ratan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004483:Ectropion / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013709:Tendon Transfer / Q000379:methods*