Tarsorrhaphy

Tarsorrhaphy is a surgical procedure that partially or completely fuses the eyelids together to narrow the palpebral fissure. By reducing lid opening, it protects the cornea from exposure and aids healing in conditions where eyelid closure is incomplete or insufficient.

Indications include exposure keratopathy caused by facial palsy, proptosis, lagophthalmos, or severe dry eye; persistent epithelial defects or neurotrophic ulcers; corneal ulcers requiring protection during healing; post-keratoplasty or other ocular surface procedures; and in infants or children at risk of corneal damage due to eyelid malposition.

Techniques are typically categorized as temporary or permanent. Temporary tarsorrhaphy uses reversible methods such as external sutures with bolsters or mattress sutures, skin adhesive, or other less invasive supports to approximate the lids for a defined period. Permanent tarsorrhaphy involves freshening the lid margins and excising a strip of tissue from the anterior lid margin or posterior lamella, followed by suturing to create a lasting closure. Partial, lateral, medial, central, or full-thickness variations may be employed depending on the location and extent of protection needed.

Outcomes include reduced exposure, improved corneal healing, and protection of vision in at-risk patients. Potential complications include lid malposition or cosmetic distortion, infection, granuloma formation, scarring, and the need for revision or reversal in some cases.

Postoperative care typically involves topical antibiotics and lubricants, eyelid hygiene, and regular follow-up to monitor healing and adjust the degree of closure if a reversible method is used.