Standardized reattachment of the lateral canthal tendon in the swinging lower eyelid approach: A step-by-step...

Lateral canthotomy is a commonly used adjunctive technique to the transconjunctival approach in the so-called "swinging lower eyelid" procedure to enhance orbital exposure. Despite its widespread use, the closure phase remains sparsely detailed in the literature, although it is critical for accurate restoration of the lateral canthal anatomy and prevention of eyelid malposition. This technical note details a step-by-step method for lateral canthotomy closure designed to achieve anatomic reconstitution of the native canthal architecture while preserving the exposure benefits of canthotomy. The protocol emphasizes identification and sequential reattachment of the inferior limb of the lateral canthal tendon. Key anatomical landmarks, technical pearls, and common pitfalls are highlighted to enhance reproducibility and facilitate surgical teaching. This standardized closure approach may improve consistency in surgical practice and provide a framework for future studies correlating closure techniques with functional and aesthetic outcomes.