The pulley canthopexy for residual telecanthus after hypertelorism repair or facial trauma.

The onset of canthal drift after hypertelorism repair can nullify the effectiveness of the repair, despite roentgenographic evidence of normal interorbital distance. The problem of hypertelorism is simply replaced by the problem of telecanthus. An excess of bulky tissue between the orbits contributes to the problem. A procedure is described in which excess soft tissue (fat, nasal muscles, and parts of the orbicularis oculi) are excised. A pulley canthopexy with a figure-of-eight suture of polypropylene is performed to bring the canthal tendons together using a hollow awl with a removable handle. The pulley gives a 4 to 1 mechanical advantage to the suture, adding control and distributing the forces over a wider area. The pulley canthopexy is a valuable tool not only in congenital anomalies but also for correcting long-standing traumatic telecanthus and acute detachment of the canthal ligaments.