Bibliographic record
Abstract
Medial canthal tendon (MCT) laxity is a common condition, usually age related and often causing symptoms of epiphora, discharge, irritation, and redness. MCT repair is more complicated than that of its lateral counterpart because of the intimate relation with the canaliculus (Fig 1). The position and patency of the canaliculus can be affected by any surgery to the canaliculus. Because of the problems with surgical repair, surgery is often delayed until the MCT laxity is advanced (Fig 2) Figure 1 Anatomy of medial canthal tendon. Figure 2 Severe MCT laxity. For this clinical controversy, a panel of five eyelid surgeons was invited from Canada, England, France, and the United States to give their management for the symptomatic patient with MCT laxity and their surgical techniques according to the degree of laxity (Table 1). View this table: Table 1 Questions regarding the lax MCT The lateral canthal tendon (LCT) is much weaker than the MCT and most cases of lid laxity involve the LCT more than the MCT. Therefore, most cases of lid laxity are best corrected with the lateral tarsal strip (LTS) procedure (Fig 3).1,2 I grade MCT laxity with the amount of lateral displacement of the punctum—that is, as mild with minimal displacement, moderate with several millimetres, or severe with displacement to the medial limbus. With mild to moderate medial ectropion or punctal eversion, I combine the LTS with a medial spindle procedure3 behind the punctum which tightens the conjunctiva and lower lid retractor to roll in the eyelid margin. I only repair the MCT if severe medial ectropion is present or lateral tendon tightening would displace the punctum too far laterally creating cosmetic or functional deformity. Figure 3 Lateral tarsal strip. For moderate to severe amounts of MCT laxity I prefer a posterior limb plication. I make a small incision behind the caruncle and an incision …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".