This is a prospective study of a new technique for repair of medial ectropion associated with medial canthal tendon (MCT) laxity. The procedure was performed on 79 eyes and involved excision of an ellipse of tissue from below the punctum including part of the caruncle medially, tarsal plate laterally and lower lid retractors inferiorly. The defect created was then closed with a circular purse-string type suture drawing the tarsus towards the caruncle and elevating the retractors. The authors make the point that extending the incision to include the caruncle exposes the posterior limb of the medial canthal tendon, and suturing the tarsus to this corrected the laxity and maintained the normal alignment of the lid to the globe. It is not clear why the purse string suture needs to be passed through the skin and tied over a bolster, as this implies the retractors have not been sufficiently advanced and an extra inward rotation of the lid margin is needed. Also a simultaneous lateral canthal tightening / repositioning procedure was required in 52 eyes which had significant residual lid laxity after the medial purse string was placed. These may both reflect the theoretical problem with the purse string suture which inevitably bunches up the tissue rather than reapposing the retractors to the tarsal plate in a vertical plane and the tarsus to the MCT in a horizontal plane. Despite this there are good results from this procedure, with 78% of those with epiphora having complete resolution of tearing. Medial ectropion associated with significant MCT laxity remains a surgical challenge, but this new technique deserves consideration based on the good outcomes reported.