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Retina & vitreous · practice question

Why does a lateral tarsal strip re-anchor to this tubercle rather than to the rim surface?

[READINESS SEED] The lateral canthal tendon anchors the tarsal plates to the lateral orbital tubercle inside the rim. Why does a lateral tarsal strip re-anchor to this tubercle rather than to the rim surface?

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Answer: A. It restores the lid's posterior vector

The lateral canthal tendon inserts on the Whitnall (lateral orbital) tubercle just inside the rim, holding the lid margin back against the globe. Re-anchoring a tarsal strip to the tubercle — not to the anterior rim — reproduces this posterior vector, so the tightened lid hugs the eye instead of standing away from it. The lateral (Whitnall) orbital tubercle is the common insertion for four structures: the lateral rectus check ligament, the lateral horn of the levator aponeurosis, the lateral canthal tendon, and Lockwood's suspensory ligament. The superior transverse (Whitnall) *ligament* is a separate structure that attaches to the orbital wall roughly 10 mm above the tubercle via the fascia of the lacrimal gland — it does not insert on the tubercle itself.

Clinical pearl: Anchoring too anteriorly (to the rim surface) leaves the lid pulled off the globe — a common cause of persistent tearing or lateral ectropion after tightening.

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