Laxity of the medial canthus tendon can result in malposition of the lower eyelid. The lateral distraction test can help to determine appropriate management of the patient.
Reference point: punctum of the lower eyelid
In the lateral distraction test, the lower eyelid is pulled laterally. The location of the punctum under this traction relative to the iris and pupil correlates with laxity of the medial canthus tendon.
Position of the Punctum
Grade
no lateral movement
0
in-between
1
medial edge of the iris
2
in-between
3
middle of the pupil
4
in-between
5
lateral edge of the iris
6
Grade
Management on Medial Canthal Ligament
0 or 1
no surgery
2
stabilization only if there is marked horizontal eyelid laxity
3 or 4
plication (stabilization suture); may require fixation to posterior lacrimal crest
5 or 6
posterior fixation or resection
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