• Flaccid eyelids commonly have a history of gradual onset of epiphora, which is aggravated by cold weather and wind. The natural history starts in middle age; as age increases, flaccidity increases. When the flaccid eyelids are surgically improved by a lateral canthal tendonesis, epiphora is greatly diminished.
The surgical technique of tenodesis is accomplished by making an 18-mm skin incision at the lateral canthus. The pretarsal and preseptal portions of the orbicular muscle are mobilized, and the raphe is incised. The lateral canthal tendon is dissected and a 2-0 black silk suture is orthopedically placed so it pulls the tendon into a drilled hole near Whitnall's orbital tubercle. Cautery is applied to the cut ends of the upper and lower mobilized muscle. The pretarsal and preseptal muscles are resected 5 mm. The skin is approximated and the 2-0 suture is tied over a button and left in place for six weeks.