What is Tarsorrhaphy: Overview, Benefits, and Expected Results

## What is Tarsorrhaphy?



Tarsorrhaphy is a ‌surgical procedure that ⁣is used to decrease ⁤the amount of exposure of the eye or eyelid. This procedure involves temporarily suturing together the two ⁢sides⁤ of ‌the eyelid‌ to narrow the opening​ of the eyelid, making it less vulnerable to injury and providing extra protection from environmental elements. Tarsorrhaphy is usually⁣ performed on patients who are at risk ‍for severe eye dryness, have very‍ active blinking,⁤ active involuntarily ocular surface movements,‌ or any other disorder that affects the ⁢eyes.



This surgical procedure ​is most commonly used to reconstruct the‌ eyelid margin after trauma or surgery, or ‌to correct conditions such as entropion,​ ectropion, strabismus,⁤ ptosis, and blepharospasm. Tarsorrhaphy has also ⁢been used to​ provide relief ⁤for people with a variety of eye diseases—from dry eye syndrome to corneal ulcers, as well as for others‌ who cannot properly protect and lubricate their eyes.



## Overview



Tarsorrhaphy is a form of reconstructive plastic surgery ⁣performed on the eyelid that involves narrowing the opening of‌ the‌ eyelid by suturing ⁣together the upper and lower⁤ eyelid margins. ‍The primary goal of the procedure is to reduce the amount ⁣of exposure of the eyes to outside elements, providing extra protection for the eyes and preventing further damage or deterioration. The procedure ​is commonly used ⁤to ⁤treat entropion, ectropion, strabismus, ptosis, and blepharospasm, as well as to help manage the symptoms of dry eye syndrome and other eye diseases.



The procedure itself involves numbing the area and surgically suturing⁢ both sides of the upper and lower eyelids⁢ together to narrow​ the opening. The suturing may be done using permanent stitching material, which requires the patient to ‌later undergo a second procedure to un-suture the eyelids, or with stainless steel wire that is easily cut and⁣ removed ‌later without⁢ a second procedure. ⁢Post-operative care typically involves the use ⁤of lubricating eye drops to stimulate proper healing and reduce the risk of infection.



## Benefits of Tarsorrhaphy



Tarsorrhaphy is a minimally invasive procedure that has the potential to bring ⁢relief to people with a variety of eye‍ conditions. The benefits of ‌this procedure include:



– ⁣Protection of the eyes from foreign objects, dust, and debris

– Increased tear⁣ production and‌ lubrication of the eyes, which helps manage dry eye syndrome and other eye ailments

– Decreased risk of eye injuries and further‍ degeneration of⁤ the eyelid

– Improved vision and eye comfort ‍for patients with drooping ‍eyelids



## Expected Results



The goal of tarsorrhaphy is ⁢to reduce the ⁤amount of exposure of the eyes⁤ and provide protection to the eye while still preserving the⁤ patient’s vision. Most ​patients experience​ some improvement in their symptoms​ following the procedure, while some patients may not experience a full resolution of their symptoms.



Generally, patients can expect the following results from tarsorrhaphy:



– ⁤Improving the eye’s comfort and vision

– Preserving the eye’s ⁤lubrication

– Preventing further damage to the eyelids from dryness, dust⁤ and debris

-⁤ Reducing the risk of infection

– A lower eye pressure, reducing​ the risk of serious ⁢damage from glaucoma



The results of tarsorrhaphy are typically long lasting, ​and ​the sutures ⁣that are used⁢ to hold the eyelids together will eventually dissolve on their⁤ own over time in most ⁤cases. However, in ⁢some cases, additional correction surgery may be necessary.



## Risks



As with all surgical procedures, there are potential ‌risks associated with tarsorrhaphy. The risks associated⁤ with this procedure are typically minor⁣ and ‍may include:



– Swelling and bruising of ​the eye and surrounding area

-⁢ Watery eyes

– Mild discomfort

– Prolonged healing time

– Scarring of the eyelid



In some cases, a second procedure⁢ may be ⁣required to remove the suture material⁣ after the⁤ healing ⁢process ‍is complete.



## Final Thoughts



Tarsorrhaphy is a minimally invasive surgical​ procedure used to narrow the ​opening of the eyelid, increasing protection and reducing the vulnerability of the eyelid and eyes to external ⁣environmental elements ⁣such ⁤as dust, debris, ⁤and dryness. The procedure has been used to treat a variety of eye‌ conditions and diseases, and can help improve comfort and vision for patients.⁢



The risks of the procedure are considered to‍ be minor and typically include swelling, bruising, mild discomfort, and prolonged healing‌ times. The results of ​the procedure are typically long ⁣lasting, and the sutures used to hold the​ eyelids‌ together will eventually dissolve on ⁣their own over time. For those suffering from‍ certain eye⁣ conditions, tarsorrhaphy can be a beneficial, long-term solution that can help reduce the risk of further damage or deterioration.



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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.

References:

• 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

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