Posterior Medial Canthal Thermoplasty.

PURPOSE To describe a new, simple, quick, and minimally invasive surgical technique for managing medial canthal tendon laxity. METHODS The technique works by creating a directed posterior lamellar scar. Sutures are preplaced in firm medial canthal tissue, and a triangular diathermy burn is made between this fixation point and the medial tarsal plate (sparing the canaliculus). This area is then plicated horizontally by bringing the preplaced sutures through the medial tarsal plate. The authors report a retrospective case note review of a consecutive case series of 55 patients (59 procedures). All patients with moderate to severe medial canthal tendon laxity underwent a medial thermoplasty procedure in addition to standard surgery for correcting their eyelid malposition (entropion, ectropion, or symptomatic lax eyelids). RESULTS The study cohort included 30 men and 25 women, with a mean age of 77 years (range 51-93). Epiphora was the commonest presenting complaint (47%) followed by ocular irritation (44%), with the remainder heaving a combination of symptoms. Lower eyelid ectropion (n = 30, 51%) and entropion (n = 26, 44%), constituted the most common indications for surgery. The average postoperative follow-up period was 16 months (range 3-63 months). Fifty-three eyes (90%) had complete resolution of symptoms, while 2 (3.4%) had partial reduction of epiphora. With regard to the eyelid margin position, 57 eyelids (96.6%) were anatomically in a normal position, while 2 operations failed despite early satisfactory results. In terms of correction of medial canthal tendon laxity, 49 cases (83%) were deemed successful. There were no major complications, nor any significant long-term sequelae. CONCLUSION Posterior medial canthal thermoplasty provides a simple, effective, and safe option for addressing medial canthal tendon laxity.