Lateral Tarsal Strip with Upper Canthoplasty
This is Richard Allen at the University of Iowa. This video demonstrates a lateral tarsal strip with an upper canthoplasty. This is a variation of a lateral tarsal strip which also includes tightening of the upper eyelid.
A lateral canthotomy is performed with the monopolar cautery or 15 blade.
An inferior cantholysis is then performed with the monopolar cautery or scissors.
Westcott scissors are then used to dissect between the anterior and posterior lamella along the length of the proposed strip, which is usually about 5-10 mm, depending on the laxity of the eyelid.
The mucocutaneous junction is then excised with Westcott scissors along the length of the strip.
The posterior surface of the strip is then scraped with a 15 blade.
The strip is then shortened the appropriate amount with Westcott scissors. This is usually between 3 and 5 mm, again depending on the laxity of the eyelid.
A 4-0 Mersilene suture on an S-2 needle is then placed so that each needle exits the anterior surface of the strip.
The needle then engages the periosteum of the lateral orbital rim at the level of Whitnall's tubercle which is approximately 2 mm superior to the medial canthus.
The suture is placed posterior to the lateral orbital rim through the periosteum.
The other arm of the suture is placed in the exact same manner.
Again, this is a half circle needle which is useful to use in these tight spaces.
An upper canthoplasty is performed by excising the mucocutaneous junction of lateral 4-5mm of the upper lid with Westcott scissors.
A 5-0 vicryl suture then engages the upper border of the tarsal strip.
This suture is then placed through the area of the denuded mucocutaneous junction along the upper lid.
This suture is then tied.
Again, this is all performed prior to tying the lateral tarsal strip sutures. This connects the upper and lower lid laterally.
The Mersilene sutures are then tied, and by doing this the upper lid is tightened as well as the lower lid.
The lash follicles of the anterior lamella of the area corresponding to the lateral tarsal strip are excised with Westcott scissors.
The canthus is then reformed by suturing the anterior lamella to the lateral tarsal strip medial to the lateral orbital rim.
The remaining sutures are then placed lateral to the lateral orbital rim to repair the canthotomy. The suture used here is a 5-0 fast-absorbing suture.
This patient also had a medial spindle performed.
Antibiotic ointment is placed over the area.
As you can see demonstrated, both the upper and lower lid are tightened.