Complex Medial Canthal Tendon Laceration: Sequence of Repair

Introduction: The medial canthal tendon is crucial for supporting the medial canthus, and eyelid lacerations disrupting it can result in devastating cosmetic and functional complications, including irregular eyelid contour, abnormal tear drainage, compromised protection of ocular surfaces, and ectropion. A detailed understanding of the tendinous and lacrimal anatomy is imperative for a successful surgical repair. Existing literature discusses several surgical approaches to medial canthal tendon laceration repair. Multiple studies outline different techniques ranging from full-thickness skin grafts or local flaps to lacrimal duct stenting with primary closure that resulted in desirable functional and cosmetic outcomes. 1 – 5 Furthermore, algorithms have been created to guide reconstruction techniques based on the location and mechanism of the defect. 6 – 7 Despite ample literature regarding repair techniques, there is a paucity of literature emphasizing the sequence of repair needed for a desirable functional and cosmetic outcome. This demonstration aims to emphasize a sequence of complex medial canthal tendon laceration repair that has not been previously described. The proposed sequence of repair includes lacrimal intubation, medial canthal tendon repair, and lid margin repair, respectively. Repairs performed in this chronology ensure patency of the lacrimal system while recreating crisp lid margin definition, resulting in desirable functional and cosmetic outcomes. Materials and Methods: Standard prep materials for the sterile procedure, lacrimal probe set, Crawford stent, Castroviejo needle driver, Castroviejo 0.5 mm forceps, and suture (4-0 undyed Vicryl and 5-0 fast gut or 6-0 Prolene). Results: The final result is a strongly anchored medial lid attachment, a patent lacrimal system, and a crisp lid angle for a functional and cosmetic repair. Results: The proposed sequence of repair includes lacrimal intubation, medial canthal tendon repair, and lid margin repair, respectively. Repairs performed in this chronology ensure patency of the lacrimal system while recreating crisp lid margin definition, resulting in desirable functional and cosmetic outcomes. Disclosure Statement: The authors have no disclosures. Runtime of video: 4:15.