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. 2019 Jun;33(6):925-929.
doi: 10.1038/s41433-019-0347-9. Epub 2019 Feb 1.

Medial canthoplasty for the management of exposure keratopathy

Robi N Maamari  1 , Philip L Custer  1 , Michael G Neimkin  1   2 , Steven M Couch  3
Affiliations

Medial canthoplasty for the management of exposure keratopathy

Robi N Maamari et al. Eye (Lond). 2019 Jun.

Abstract

Purpose: To report the surgical technique and functional outcomes of the medial canthoplasty for the treatment of exposure keratopathy.

Patients/methods: An IRB approved, retrospective review of patients who underwent medial canthoplasty for exposure keratopathy was performed. Patient demographics, reported symptoms, and clinical examination findings were collected and analyzed from pre-operative and follow-up visits.

Results: The study included 73 consecutive cases in which the medial canthoplasty was performed in patients with exposure keratopathy. The average follow-up period was 7.9 months (median: 4.7 months; range: 1-150 months). Complete or partial improvement in ocular symptoms (dryness; pain/irritation; tearing) was achieved in 95% (69/73). Clinically, 85% (41/48) of patients demonstrated a post-operative reduction in lagophthalmos and 90% (60/67) showed improvement in ocular surface findings. Complications were rare (1/73) and reversal of medial canthoplasty was not required in any case.

Conclusions: The medial canthoplasty appears to be a safe and effective technique to narrow the palpebral fissure, provide lower eyelid support, and improve keratopathy. It is an uncomplicated procedure that may be considered for the treatment of exposure keratopathy caused by facial paralysis and lower eyelid malposition.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Surgical technique. a An incision is created at the mucocutaneous junction medial to the upper and lower puncta. b Undermining of the skin flaps results in upper and lower medial canthal tendon exposure. c The upper and lower canthal tendons are adjoined with interrupted polyglactin sutures. d The skin flaps are closed with interrupted gut sutures
Fig. 2
Fig. 2
Representative photographs of a patient with bilateral lower eyelid retraction. a Pre-operative photograph. Note the inferior scleral show and increased medial canthal exposure present bilaterally. b Post-operative photograph. Following bilateral treatment with medial canthoplasty, the patient demonstrates narrowing of the vertical fissure with reduced inferior scleral show and a subtle decrease in horizontal palpebral length, providing improved medial eyelid support and diminished ocular exposure nasally
See this image and copyright information in PMC

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