What is Canthopexy?
Canthopexy is a surgical procedure that tightens and repositions the lateral canthal tendon without cutting or detaching it, used to prevent or correct lower eyelid malposition, particularly ectropion and laxity. 1, 2
Surgical Technique
Canthopexy involves suture-based resuspension of the lateral canthal structures to the periosteum of the lateral orbital rim, performed through either an upper or lower eyelid incision without externalization at the lateral canthal angle. 2 The procedure can be accomplished through several technical approaches:
Transpalpebral approach: Sutures are passed through the eyelid incision to capture the lateral canthal tendon and secure it to the periosteum without creating an external canthotomy. 2, 3
Minimally invasive technique: Percutaneous placement of canthopexy sutures through the confluence of the lateral superior and inferior grey lines at the lateral canthal angle. 4
Transorbital approach: Direct fixation through the lateral orbital rim for more durable adjustment of the lateral canthus. 5
Indications for Use
Canthopexy is indicated when lower eyelid laxity is present but lid distraction distance is less than 10 mm. 1 Specific clinical scenarios include:
Prophylactic use during lower blepharoplasty: Applied in 98% of lower eyelid cosmetic surgery cases to prevent postoperative ectropion or malposition, regardless of patient age or preoperative assessment. 1
Mild to moderate eyelid laxity: When horizontal eyelid shortening is not necessary to achieve adequate tightening. 2
Involutional ectropion with less severe laxity: As an alternative to more extensive canthoplasty procedures. 2
Distinction from Canthoplasty
The critical difference between canthopexy and canthoplasty lies in the degree of surgical intervention:
Canthopexy: Suture-based tightening without cutting the lateral canthal tendon or shortening the eyelid horizontally. 2, 3
Canthoplasty (e.g., lateral tarsal strip): Involves cutting, shortening, and reattaching the lateral canthal tendon, necessary when lid distraction distance is ≥10 mm or in cases of profound eyelid laxity or severe ectropion. 1, 2
Clinical Outcomes
Canthopexy procedures demonstrate high success rates with minimal complications:
83% average reduction in patient-reported discomfort following lateral transorbital canthopexy. 5
No surgical failures or complications reported in prospective series of 16 procedures. 5
Excellent cosmetic results with prevention of eyelid malposition when used prophylactically during blepharoplasty. 1
Common Pitfall
The most important clinical consideration is proper patient selection: canthopexy alone is insufficient for severe eyelid laxity (≥10 mm distraction distance), which requires canthoplasty with horizontal lid shortening. 1, 2 Using canthopexy in cases requiring canthoplasty will result in inadequate correction and potential surgical failure.