A tarsorrhaphy is a mainstay procedure for oculoplastic surgeons. There are many situations where a tarsorrhaphy or eyelid suturing is necessary. As an eyelid specialist it is a common procedure that is performed by myself. What are the situations where this procedure is performed? It should be known that the tarsorrhaphy is a common procedure but one that is done only when necessary. Because as one can see it distorts the appearance of the eyelid, we do not make the decision to do this procedure lightly. We perform the procedure to reduce the risk of permanent damage to the cornea,scarring of the cornea or blindness.
A tarsorraphy is done under local anesthesia in the office. Once the eyelid is numbed, stitches are placed to close the corners of the eyelids. Sometimes the entire eyelid is closed whereas other times, only a small part of the eyelid needs closing. Antibiotic ointment is placed afterward.
There are different types of tarsrorhappy: Complete, partial, permanent and temporary. These are all done depending on the length of the eyelid that needs closing and whether the eyelid needs to be closed for less than or greater than two weeks.
The following are the most common situations where a tarsorrhaphy needs to be done and when I perform this procedure on my patients in Denver, Colorado.
1.Nonhealing corneal ulcer/abrasion
A nonhealing corneal ulcer or abrasion occurs when the surface of the eye (cornea) has sustained damage or some infection. Often the cornea can heal on its own but sometimes when there is advanced damage, the eyelid has to be shut to allow the eye to heal.
2. Advanced dry eye
Some patients with advanced dry eye need a tarsorrhaphy or eyelid closure procedure to reduce the open space of the eyelid. By closing or reducing the aperture of the eyelid, the eye will have reduced evaporation of tears and as a result have a better chance of staying wet. Often a small tarsorraphy is done since this is a more permanent solution. In certain dry eye conditions like Sjogren's disease or damage to the lacrimal gland, larger tarsorrhaphies have to be performed.
3.Bell’s Palsy or Facial Nerve Palsy
After a stroke to the facial nerve (the nerve that performs facial expression such as smiling or closing the eye, the eyelid has to be closed temporarily to allow the eyelid to close and protect the cornea. Sometimes the eyelid function returns and the tarsoraphhy can be released if the effects of the palsy are temporary. There are other things that can be done to help these patients if the facial nerve palsy is long term. In Denver patients with Bell’s palsy that doesn’t get better procedures like canthoplasty or gold/platinum weight placement can be done.
4. Eyelid Retraction after Blepharoplasty and Cosmetic Eyelid Surgery
An uncommon and feared complication after blepharoplasty is eyelid retraction. In that case the eyelid can be pulled down and the patient can have trouble closing the eye. Patients with eyelid retraction may have improvement with temporary tarsorrhaphy to close the eyelids or stretch the skin. This is cosmetically unacceptable to most patients but may be a necessary step to help solve this problem.
5. Graves Disease and Proptosis
When patients have bulging eyes such as in graves disease, there are situations where the eyelids are temporarily shut before further surgeries such as orbital decompression are done to help protect the cornea. This is done not only in Graves or thyroid eye disease but other diseases such as orbital tumors before the patient is brought to the operating room.