title: Caruncular fixation in medial canthal tendon repair: the minimally invasive purse string suture for tendinous laxity and medial ectropion.
abstract: OBJECTIVE
  To describe a surgical technique for repair of medial ectropion that simply and reliably addresses tendinous laxity and punctal eversion.
  
  
  METHODS
  Prospective, single-blind, consecutive case study of 54 patients (79 eyes) by 3 surgeons. The subject population consisted of 33 males and 21 females, with a mean age of 81 years (SD = 9, range = 64-97). The presenting mechanisms of ectropion were as follows: cicatricial (n = 10), paralytic (n = 1), involutional (n = 62), mechanical (n = 3), and congenital (n = 3). Ectropion and punctal eversion was surgically addressed by use of a purse string suture that incorporated closure of a medial spindle incision and deep fixation to the base of the caruncle.
  
  
  RESULTS
  The average postoperative follow-up period was 147 days (SD = 291, range 8-2,352). Sixty-four eyes had a presenting complaint of tearing (81%), with 50 eyes (78%) achieving complete resolution (p = 0.0001). Eyelid malposition was determined to be anatomically corrected in 34 of 35 eyes (97%, p = 0.0001). Four of the 79 operated eyelids had recurrence of ectropion (5%). All other reported complications were minor, resolved without sequalae.
  
  
  CONCLUSIONS
  The technique demonstrated safety, efficacy, and reproducibility, regardless of ectropion mechanism. Incorporation of a purse string suture between the lower eyelid portion of the medial canthal tendon and the caruncle produces a reliable posterior-superior fixation parallel to the vectors of the posterior limb of the medial canthal tendon. This technique is equally effective as a primary correction method or when used in combination with other procedures.
authors.affiliation: *Division of Ophthalmology, Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth Doctor's Hospital, Columbus, Ohio; †Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, Ohio; ‡Department of Ophthalmology and Otolaryngology, Drexel University College of Medicine, Philadelphia, Pennsylvania; §Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania; ‖Department of Medical Education, The Ohio State University School of Medicine, Columbus, Ohio, U.S.A.
authors.forename: Craig N
authors.initials: CN
authors.lastname: Czyz
authors.forename: Allan E
authors.initials: AE
authors.lastname: Wulc
authors.forename: Christina L
authors.initials: CL
authors.lastname: Ryu
authors.forename: Jill A
authors.initials: JA
authors.lastname: Foster
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Edmonson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000601:surgery*; D004483:Ectropion / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D016037:Single-Blind Method; D013536:Suture Techniques; D013710:Tendons / Q000601:surgery*