The lateral palpebral ligament (lateral canthal tendon) is the fibrous band connecting the lateral ends of the superior and inferior tarsal plates to the Whitnall tubercle on the inner surface of the lateral orbital wall, a few millimetres behind the orbital rim. Its upper and lower limbs join before inserting. It is reinforced by the lateral check ligament of the lateral rectus, the lateral horn of the levator aponeurosis, and fibres from the orbital septum, forming the lateral retinaculum.
| Origin | Lateral orbital (Whitnall) tubercle of the zygomatic bone |
|---|---|
| Insertion | Lateral ends of the upper and lower tarsal plates |
Anchors the lateral canthus to the lateral orbital wall, maintains the upward tilt of the lateral canthal angle (approximately 2-4 mm higher than the medial canthus in young adults), and provides resistance to inferior displacement of the lower eyelid.
The lateral palpebral ligament is the primary structure tightened in lower eyelid laxity procedures (lateral tarsal strip, canthopexy, canthoplasty). Age-related attenuation produces lower eyelid sagging, ectropion and lateral canthal rounding. The tendon must be precisely reattached at Whitnall tubercle in zygomatic fracture repair, and its stump anchors the reconstructed lid after tumour resection. Lateral canthotomy with cutting of the inferior limb (inferior cantholysis) is an emergency procedure to relieve orbital compartment syndrome from retrobulbar haemorrhage, and is also used in orbital decompression.
Attenuation of the lateral palpebral ligament and lid retractors in the elderly produces outward turning of the lower lid margin, causing epiphora and exposure keratitis, corrected by lateral tarsal strip procedure reattaching the tightened tarsus to Whitnall tubercle.
Zygomatic complex fractures displace the lateral orbital rim and Whitnall tubercle, avulsing the lateral palpebral ligament and producing lateral canthal rounding and dystopia requiring anatomic fracture reduction and canthopexy.
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