A canthopexy is a procedure to support the lower eyelid in patients with poor lower lid tone. This is often detected by a lid distraction test or while performing a lid retraction (snap back) test. Patients at risk for poor lower lid tone and the sequelae of an ectropion or scleral show are those with a poor snap back test, distraction test, and a negative vector or very flat cheeks. A canthopexy is performed by placing a suture through the lateral canthal ligament and suspending it to the periostium (or connective tissue) along the inner lateral orbital rim. My analogy is like suspenders on a pair of pants that hold the lower lid in place during the healing process. Early post-op, the patient’s eye may appear slightly almond shaped, but as the area heals the shape usually returns to normal.