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Medial canthal tendon release and lower eyelid retractor plication for Centurion syndrome
Abstract
Centurion syndrome is an uncommon, idiopathic medial canthal anomaly that causes epiphora due to the forward displacement of the lacrimal punctum out of the tear lake associated with the abnormal anterior insertion of the medial canthal tendon and enophthalmos. A case of Centurion syndrome is presented together with the description of a previously unreported surgical treatment: The combined surgical techniques of medial canthal tendon release and lower eyelid retractor plication. © 2006 Royal Australian and New Zealand College of Ophthalmologists.
Centurion syndrome is a rare medial canthal tendon insertion anomaly that causes epiphora in young adults. The purpose of the current study
is to describe the clinical signs and outcome of surgery in a 18-year-old male patient with Centurion syndrome. Ophthalmic examination
revealed bilateral loss of lid globe apposition medially, with anterior displacement of the lacrimal puncta out of the tear lake and a prominent
nasal bridge. The patient, whose findings were consistent with Centurion syndrome, underwent bilateral medial canthal tendon release and
medial tarsoconjunctival resection. Tearing was completely resolved after surgery. Anterior medial canthal tendon release with medial
conjunctivoplasty is an effective surgical approach in patients with Centurion syndrome. (Turk J Ophthalmol 2012; 42: 243-5)
To describe the clinical signs and outcome of surgery in cases with Centurion syndrome and highlight the clinical presentation of this syndrome.
A retrospective review of records of patients with Centurion syndrome who underwent surgery between January 2002 and July 2007. The position of the punctum, nasal bridge prominence, Hertel exophthalmometry and the presence of inferiorly directed sharp angulation of the medial canthus was noted. The patients underwent anterior canthal tendon release, punctoplasty or medial conjunctivoplasty or a combination of these.
Of the 13 cases, 10 had been treated medically elsewhere. The mean age of onset was 20.7 years. Most of the patients were male 10 (76.9%). A prominent nasal bridge was demonstrable in 9 (69.2%) patients and sharp inferior angulation of the medial canthus, the 'beak' sign was present in 9 (69.2%) cases. Anterior canthal tendon release alone was performed in 4 patients, in combination with punctoplasty in 5 and with conjunctivoplasty in 4. Watering resolved in 10 patients. 3 patients who had a combination of anterior canthal tendon release and punctoplasty had persistent but asymptomatic epiphora.
Centurion syndrome is characterised by the abnormal anterior insertion of the medial canthal tendon with displacement of the punctum out of the lacrimal lake. Most cases present with unexplained watering. Surgical management by anterior canthal tendon release with or without conjunctivoplasty or lower lid retractor plication is usually successful.
To describe the clinical features and treatment outcomes in patients with the centurion syndrome.
Review of medical records.
Forty patients, 38 of whom were male, were examined. Epiphora commenced during the second decade of life in all patients. Fluorescein dye pooled near the medial canthus because of anterior displacement of the medial lower eyelid and inferior punctum. Probing of the canaliculi and irrigation of the lacrimal drainage system confirmed anatomic patency in all patients. Disinsertion of the anterior limb of the medial canthal tendon relieved epiphora by restoring normal apposition between the lower eyelid and the globe in all 22 patients who underwent surgery.
Centurion syndrome is a unique clinical entity that may manifest as epiphora during puberty. Outcomes of surgical correction are favorable.
A simplified procedure is proposed for the repair of medial lower eyelid age-related ectropion.
A posterior horizontal incision is made in the medial half of the lower eyelid at the inferior border of tarsus. The lower eyelid retractors are exposed and then plicated to the tarsus without excision of posterior lamellae or the use of everting sutures. The lid is then shortened horizontally with excision of a pentagonal section or lateral tarsal strip procedure.
The procedure was performed in six patients successfully without complication.
This is an effective method for repair of lower lid medial age-related ectropion.
To investigate the effectiveness of anterior canthal tendon release in the management of centurion syndrome.
Four patients diagnosed as having the centurion syndrome were treated over a period of 3 years. They all underwent bilateral anterior canthal tendon release under local anesthesia.
None of these patients had adequate apposition of the lower puncta after surgery. One patient had partial relief of epiphora on one side.
Our results indicate that anterior canthal tendon release is insufficient as a sole treatment for patients with centurion syndrome.