This is a retrospective photographic study of changes in the lateral canthal position following a lateral orbitotomy performed via a lateral canthotomy and cantholysis of both upper and lower limbs of the lateral canthal tendon. Reconstruction of the lateral canthus was performed with a single 4-0 vicryl suture passed in a circular fashion through the periorbital tissue, inferior crus and tarsal plate, superior tarsal plate and crus, then periorbital tissue again. Forty-one operations were assessed including 34 decompressions for thyroid eye disease. The authors measured changes in the width of the horizontal palpebral aperture, the height of the lateral canthus relative to the medial canthus, and assessed rounding of the lateral canthal angle, relating these to changes in proptosis measured clinically. They found no significant change in the horizontal width of the palpebral aperture, although there was approximately 0.2mm of reduction for every 1mm of reduction in proptosis in the decompression cases. There was a 0.13mm rise in the lateral canthal vertical position relative to the medial canthus. There was no change in the canthal angle or rounding of the canthus. The study refutes anecdotal reports of lateral canthal dystopia following lateral orbitotomy involving a lateral canthal incision which have led to alternative surgical approaches. The authors recommend their technique, suggesting it provides good access with a simple closure and no significant complications. Although this is a retrospective study it provides reasonable evidence to commend this technique. One particular weakness is the assessment of rounding of the lateral canthus, which appears to be a subjective assessment rather than a true measurement. Given this is one of the potential major criticisms of the technique, which they are refuting, more formal data would have provided a stronger argument.
Lateral canthal position after lateral orbitotomy
Reviewed by James Hsuan
Lateral canthal position following lateral orbitotomy and the influence of ocular proptosis.
