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Surgical Correction for Pediatric Epiblepharon and Trichiasis

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Published on: July 8, 2025

Mini-tenotomy procedure to correct diplopia associated with small-angle strabismus.

Kenneth W Wright¹

¹Wright Foundation for Pediatric Ophthalmology and Strabismus and the Department of Ophthalmology, University of Southern California-Keck School of Medicine, Los Angeles, California, USA.

Transactions of the American Ophthalmological Society

|February 4, 2010

Summary

The mini-tenotomy is a safe and effective minimally invasive surgical technique for treating small-angle strabismus. This procedure offers an alternative to traditional muscle recession, successfully reducing eye deviations in adult patients.

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Area of Science:

Ophthalmology
Surgical Innovation
Strabismus Treatment

Background:

Strabismus, particularly small-angle deviations, often requires surgical intervention.
Traditional rectus muscle recession involves significant muscle manipulation and scleral reattachment.
A novel, minimally invasive approach is needed to simplify strabismus surgery.

Purpose of the Study:

To evaluate the efficacy and safety of the mini-tenotomy technique for treating small-angle strabismus.
To compare the mini-tenotomy as an alternative to standard rectus muscle recession.

Main Methods:

Retrospective chart review of 15 adult patients undergoing the mini-tenotomy procedure.
A 3 mm central tenotomy was performed through intact conjunctiva using blunt scissors.
Preoperative and postoperative deviation measurements (esotropia and vertical deviations) were analyzed.

Main Results:

Preoperative esotropia averaged 8Δ (range 2-16Δ); vertical deviations averaged 3.5Δ (range 2-6Δ).
Postoperative esodeviations averaged 5.8Δ (range 1-8Δ); hyperdeviations averaged 1.3Δ (range 0-4Δ).
Greater mean improvement was observed for hypertropia (2.3Δ) compared to esotropia (1.3Δ).

Conclusions:

The mini-tenotomy is a safe and effective surgical option for diplopia due to small-angle hypertropia or esotropia.
This minimally invasive surgery can be performed in-office under topical anesthesia.
Multiple surgical interventions may be required for optimal outcomes, as with other strabismus procedures.