Anterior insertion of the lateral canthi
This 3 year-old boy has had recurrent epiphora since the age of one. He also suffered from recurrent attacks of conjunctivitis. On examination, he has unusual appearance of the lateral canthal regions. The lateral canthi appear to be anteriorly inserted on the periosteum of the lateral orbital rims so that the lateral lower lids are not apposed to the lids. 
Because of the recurrent conjunctivitis, he undergoes syringing and probing to exclude congenital nasolacrimal duct obstruction. The nasolacrimal ducts drain freely. The epiphora is believed to be caused by the abnormal shape of the lower lids.
No further action is taken at this stage as it is hoped that with the growth of the face the lower lids may assume a better position. If this fails to occur in the future and the epiphora proves to be troublesome, re-positioning of the lateral canthi by lateral tarsal strips may be useful.
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