Lateral Tarsal Strip
This is Richard Allen at the University of Iowa. This video demonstrates the lateral tarsal strip procedure.
A lateral canthotomy is performed with either the needle tip cautery or a 15 blade.
An inferior cantholysis is then performed with either the needle tip cautery or scissors.
Dissection is then carried out between the anterior and posterior lamella for approximately 5 to 10 mm, depending on the laxity of the eyelid.
The mucocutaneous junction is then excised along the length of the strip with Westcott scissors.
The posterior surface of the strip is then scraped with a 15 blade to denude the area of any epithelium.
The strip is then grasped and placed into position along the lateral orbital rim to determine the appropriate amount to shorten it, which is performed with Westcott scissors.
This is usually somewhere around 3-5 mm, depending on the laxity of the lid.
A double arm 4-0 Mersilene suture on an S-2 needle is then placed so that each arm exits the anterior surface of the strip.
The needle then engages the lateral orbital rim at the level of Whitnall's tubercle which is at least 2 mm superior to the medial canthus.
This is placed in the periosteum posterior to the lateral orbital rim.
The periosteal bite is confirmed by pulling on the sutures.
The second needle is placed in the same manner.
Again, the needle used here is a half circle needle which works well in small spaces.
The sutures are then tied.
The canthus is then reformed be excising the lash follicles corresponding to the anterior lamella of the strip.
The anterior lamella is sutured to the strip medial to the lateral orbital rim with a single 5-0 fast-absorbing sutures.
The remaining sutures are placed lateral to the lateral orbital rim to repair the canthotomy.
This patient also had a medial spindle performed.