Closure of the Lateral Canthotomy
The lateral canthoplasty is an oculoplastic work horse in gaining access to ocular adnexal and orbital structures in both functional and aesthetic surgery. Reconstruction of this area should be performed with special attention to reforming the lateral canthal angle and meticulous closure of the wound. One area of the wound that can be difficult to close in a satisfactory fashion is the very medial aspect of the canthotomy. This stems from my approach which includes reformation of the lateral canthal angle with an interrupted suture passed through the lower and upper portions of the lateral canthal tendon. I then permanently tie the suture that was previously passed through a lateral tarsal strip and lateral orbital rim periosteum for reattachment of the inferior crux. This results in marked tightening of the canthotomy wound especially at its medial aspect. This inward tightening of the wound can make suture placement for canthotomy closure difficult at times.
From this I began closing the medial one-half of the canthotomy wound prior to permanently cinching the suture for attachment of the inferior crux. By leaving the distal one-half of the wound open, I am able to effectively tie the anchoring suture and then close the remainder of the canthotomy in a satisfactory fashion (Fig.).
I hope this small modification helps improve the outcome, speed, and ease of lateral canthotomy closure.