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In Down's syndrome patients, surgical correction of the palpebral fissure obliquity through an external approach may produce a red, slightly hypertrophic scar. A transconjunctival approach for this repair was used for 15 Down's syndrome patients aged 3 to 17 years (mean 8.7 years), and the results were compared with those in two boys aged 6 and 17 years who underwent correction by the external approach. Palpebral fissure inclinations were recorded using anthropometric measurements pre-operatively and 6 months postoperatively. Inclinations were reduced significantly by either technique; however, often the precise degree of the improvement was clear only from the measurements rather than from photographs. Complications of the transconjunctival approach were few, and there were no problems with wound healing and no ocular injury. Transconjunctival lateral canthopexy is a safe, effective method that avoids a potentially stigmatizing external scar.