When the medial canthal ligament has been avulsed or lacerated and divided, and not reunited at the time of immediate repair, the abnormal tension will pull the lids and the medial canthal angle tissues laterally, producing a classical deformity. The longer the secondary repair is delayed, the more the resistance to correction. Sutures from the medial canthal angle to the periosteum of the nasal or lacrymal bone will pull out. To properly repair this condition, the stump of the ligament is exposed on the nasal bone, and a hole is drilled through the bone above and below the ligament.
If these openings are angled toward each other (Fig, A), it will be easier to insert a piece of wire to which is affixed one end of a piece of Supramid Extra suture (No. 8).
The inset (Fig, B) shows that after the suture has been drawn through the openings, it
CALLAHAN A. Secondary Reattachment of the Medial Canthal Ligament. Arch Ophthalmol. 1963;70(2):240-241. doi:10.1001/archopht.1963.00960050242016