Medial canthal malpositions and marked medial ectropion due to laxity, scarring, or trauma can be difficult to correct. Medial canthal tendon publications have been advocated but they do not achieve adequate posterior and medial placement of the medial canthal angle and they lack permanence. One of us (R.L.A.) has developed a surgical technique for correcting these problems that is a modification of the lateral tarsal strip procedure used to correct lateral canthal tendon laxity and malposition. The medial tarsal strip procedure repositions and tightens the medial lower or upper eyelid, establishing a normal anatomic appearance. Its use is indicated in cases of medial canthal malposition or marked medial ectropion associated with a nonfunctioning canalicular system or in those cases in which loss of function of a patent canaliculus is acceptable or desirable. The advantages of the medial tarsal strip are as follows: (1) surgery is directed at the site of the defect; (2) recurrence of canthal tendon laxity and elongation is avoided; (3) a more medial and posterior positioning of the medial eyelid can be obtained; (4) any amount of eyelid laxity can be corrected simultaneously; (5) the almond-shaped canthal angle is preserved or reestablished; and (6) the procedure is fast and easily performed.