The tarsal strip procedure.

We have developed a procedure that is particularly useful for (1) paralytic or senile upper and lower eyelid laxity, (2) lateral canthal tendon laxity or malposition, and (3) iatrogenic phimosis associated with recurrent entropion or ectropion after traditional lid-shortening procedures. Lateral canthal tendon laxity or elongation is the primary problem in the majority of these cases, and eyelid tightening with use of lateral tarsal strips corrects this deformity. The midtarsal portion of the eyelid, which is usually resected in traditional lid-shortening procedures, is seldom elongated, and recurrences of laxity are common secondary to further stretching of lax tendons. The technique involves a lateral canthotomy and transection of the appropriate crus of the lateral canthal tendon. The eyelid is then split into anterior and posterior lamellae, and tarsal strips are fashioned from the posterior lamella. The tarsal strips are sutured to periosteum at the lateral orbital wall, adjusting the height and tension of the lateral canthus. This technique gives a normal appearance to the lateral canthal angle and has yielded good results in 51 cases.