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, approximately 10 mm behind the orbital rim. 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.
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 and lateral canthal rounding. In facelift surgery, lateral canthopexy elevates the lateral canthus. The lateral canthal tendon must be precisely reattached at Whitnall tubercle in zygomatic fracture repair where the lateral orbital rim is disrupted. The upper lid lateral horn of the levator aponeurosis blends with this ligament.
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.
