Repair of the lax medial canthal tendon.

Medial canthal tendon (MCT) laxity is a common condition, usually age related and often causing symptoms of epiphora, discharge, irritation, and redness. MCT repair is more complicated than that of its lateral counterpart because of the intimate relation with the canaliculus (Fig 1). The position and patency of the canaliculus can be affected by any surgery to the canaliculus. Because of the problems with surgical repair, surgery is often delayed until the MCT laxity is advanced (Fig 2) For this clinical controversy, a panel of five eyelid surgeons was invited from Canada, England, France, and the United States to give their management for the symptomatic patient with MCT laxity and their surgical techniques according to the degree of laxity (Table 1).