Definition & Overview
Tarsorrhaphy is a surgical procedure wherein the eyelids are partially sewn together. It is performed on patients suffering from various conditions that impair the proper function of the eyelids (protect the eyes and facilitate blinking), placing the cornea at risk of drying. The procedure's main goal is to keep the eyelids partially shut so moisture can be retained in the affected eye.
Tarsorrhaphy is rarely performed but it plays a unique and very important role in the treatment of certain eyelid and corneal conditions.
Who Should Undergo and Expected Results
Tarsorrhaphy is recommended for patients who suffer from severe ocular surface disorders, corneal epithelial disorders, and conditions that cause ocular exposure. Some examples of these conditions include:
Bell’s Palsy, a nerve disorder that causes eyelid paralysis (inability of the eyelids to close or blink) or eyelid weakness, in which the eyelids cannot close completely.
Myasthenia gravis, a condition that weakens the facial muscles including the eyelids.
Stroke – Stroke patients may have difficulty controlling the movement of their eyelids.
Brain injuries – Brain injuries, which can be caused by a variety of factors, such as stroke or accidental trauma, can make the process of controlling the blinking motion of the eyes extremely challenging for patients.
Sjogren’s syndrome, which causes a reduced flow of tears.
Dendritic ulcers in the cornea – Ulcers that form on the cornea are usually caused by viruses. Although treatable, the ulcers must be given enough time to heal. To speed up this process, patients may opt to undergo a tarsorrhaphy to keep the cornea protected.
Exophthalmos or proptosis, a condition wherein the eyes stick out or protrude from their sockets, placing them at risk of drying. This may also present as a symptom of other diseases, such as eye tumours and Graves’ disease.
Enophthalmos, a disorder wherein the eye is positioned too far back in its socket, rendering normal eyelid function insufficient in protecting the cornea.
Cicatricial or scarring – Scarring, which commonly occur as a result of burns injuries, can also damage the eyelids and keep them from functioning properly.
In addition, tarsorrhaphy also helps prevent certain ocular disorders, such as chemosis or conjunctival swelling.
While a useful and effective procedure, tarsorrhaphy is usually considered as a last resort when other efforts to retain moisture in the cornea have failed. Ophthalmologists typically prescribe eye drops and the use of contact lenses first to keep the cornea moist and to protect them from direct contact with external elements.
Since the procedure is not a treatment in itself, it is usually followed by other procedures to address underlying conditions that affect the eyelids or the cornea. Once the underlying condition has been treated, the effects of tarsorrhaphy can be easily reversed.
How is the Procedure Performed?
The procedure is performed by carefully stitching the corners of the eyelids together to narrow the opening of the eye. Doing so can keep the cornea from being too exposed, thus giving it vital protection. Additionally, the procedure keeps the eyes lubricated by reducing its exposure to the air.
There are now several methods used to perform tarsorrhaphy. These include the use of:
- Cyanoacrylate glue – The lids may be joined simply by gluing them together using a substance known as cyanoacrylate glue.
- Botulinum toxin – Although more expensive, this effectively freezes the facial muscles near the affected eye.
- Suturing techniques
- Pressure patching
- Drawstring technique – Used mainly in cases where only a temporary effect is needed, this technique allows the eyes to close and open with ease.
Traditionally, when the conventional suturing method is used, its effects last between two and eight weeks, giving doctors sufficient time to examine and treat the underlying condition. After 8 weeks, all sutures will lose their original tension. If the patient's condition requires long-term effects, a permanent tarsorrhaphy can be performed, in which a part of the lid margin undergoes debridement to keep the lids sealed or narrowed.
Regardless of which technique is used, tarsorrhaphy is a quick, outpatient procedure that requires the application of local anesthesia to the upper portion of the face.
Possible Risks and Complications
Since tarsorrhaphy is a simple and straightforward procedure performed usually for temporary purposes, it carries minimal risks and little to no long-term effects.
These risks are limited to certain infections, although most of them are minor and superficial, if they do occur. They can also be easily avoided by keeping the affected eyes clean at all times and by refraining from the use of any makeup. Patients may also experience limited peripheral vision as well as some eyelid swelling, which is the body’s normal response while the eyelids are healing from the surgery.
Rajak S., Rajak J., Selva D. (2015). “Performing a tarsorrhaphy.” Community Eye Health Journal. 2015;28(89):10-11. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579993/
Kitchens J., Kinder J., Oetting T. (2002). “The drawstring temporary tarsorrhaphy technique.” Arch Ophthalmol. 2002;120(2):187-190. http://archopht.jamanetwork.com/article.aspx?articleid=269640