Tarsorrhaphie

Tarsorrhaphy is a surgical procedure in which the margins of the upper and/or lower eyelids are joined along part of their length to narrow the palpebral fissure. The goal is to decrease exposure of the cornea and eyelid surface, reduce tear evaporation, and protect the ocular surface during healing. The procedure can be temporary or permanent. Temporary methods include eyelid-margin sutures with bolsters or cyanoacrylate glue, or adhesive tape tarsorrhaphy; these are typically reversible. Permanent tarsorrhaphy involves de-epithelializing a strip of the lid margin and suturing the lid margins together, either partially or completely, and can be performed medially, laterally, or centrally depending on corneal exposure and cosmesis. The technique can be full-thickness or partial-thickness, and can be unilateral or bilateral.

Indications include exposure keratopathy from facial nerve palsy or nocturnal lagophthalmos, proptosis (as seen in thyroid eye disease), neurotrophic keratopathy or persistent epithelial defects, corneal ulcers, and protection of the cornea after ocular surface surgery or in severe dry eye. It may be used in neonates or children to protect the cornea during healing.

Outcomes and risks: tarsorrhaphy reduces corneal drying and promotes healing but can cause diplopia from over-closure, cosmetic changes, lid-margin malposition, infection, or recurrence of exposure. Reversibility is greater with temporary techniques, whereas permanent procedures may require later revision or adjustment. See also eyelid surgery and ocular protection.