Orbit, 28, 269–274, 2009 Copyright C  Informa Healthcare USA, Inc. ISSN: 0167-6830 print / 1744-5108 online DOI: 10.3109/01676830902856302 CLINICAL RESEARCH Centurion Syndrome: Clinical Presentation and Surgical Outcome Ramesh Murthy, MD FRCS, 1 Santosh G. Honavar, MD FACS, 2 Milind Naik, MD, 2 Vikas Menon, MD, 2 Anirban Bhaduri, MD, 2 and Sima Das, MD 2 1 Oculoplasty and Ocular Oncology Service and Strabismus and Pediatric Ophthalmology Service, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India 2 Oculoplasty and Ocular Oncology Service, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India ABSTRACT Purpose: To describe the clinical signs and outcome of surgery in cases with Centurion syndrome and highlight the clinical presentation of this syndrome. Methods: A retrospective review of records of pa- tients with Centurion syndrome who underwent surgery between January 2002 and July 2007. The position of the punctum, nasal bridge prominence, Hertel exophthalmometry and the presence of in- feriorly directed sharp angulation of the medial canthus was noted. The patients underwent anterior canthal tendon release, punctoplasty or medial conjunctivoplasty or a combination of these. Results: Of the 13 cases, 10 had been treated medically elsewhere. The mean age of onset was 20.7 years. Most of the patients were male 10 (76.9%). A prominent nasal bridge was demonstrable in 9 (69.2%) pa- tients and sharp inferior angulation of the medial canthus, the ‘beak’ sign was present in 9 (69.2%) cases. Anterior canthal tendon release alone was performed in 4 patients, in combination with punc- toplasty in 5 and with conjunctivoplasty in 4. Watering resolved in 10 patients. 3 patients who had a combination of anterior canthal tendon release and punctoplasty had persistent but asymptomatic epiphora. Discussion: Centurion syndrome is characterised by the abnormal anterior insertion of the medial canthal tendon with displacement of the punctum out of the lacrimal lake. Most cases present with unexplained watering. Surgical management by anterior canthal tendon release with or without conjunctivoplasty or lower lid retractor plication is usually successful. KEYWORDS: Centurion syndrome Centurion syndrome is an idiopathic and rare medial canthal anomaly; where the patient usually presents with unexplained epiphora (Sullivan et al., 1993). The patients have an abnormal anterior insertion of the medial canthal tendon and a prominent nasal bridge. The punctum is displaced out of the lacrimal lake. The term “Centurion syndrome” was derived from the facial appearance of the Roman Centurions Received 17 July 2008; accepted 28 January 2009. Address correspondence to Dr. Ramesh Murthy, Consultant Oculoplasty and Ocular Oncology, Pediatric Ophthalmology and Strabismus, L. V. Prasad Eye Institute, Banjara Hills, Hyderabad, India 500034. E-mail: drrameshmurthy@gmail.com who had a similar nasal anatomy to this subset of pa- tients (Sulllivan et al., 1993). Though uncommon, it is important to identify this anomaly as the management of this condition surgically, results in a good outcome (Sujatha et al., 1999; Welham & Hughes, 1985). In this study we describe the clinical signs and management outcome of patients with Centurion syndrome. MATERIALS AND METHODS A retrospective review of the medical records of all patients with Centurion syndrome who underwent surgery at L. V. Prasad Eye Institute from January 2002 269