Tarsorrhaphy is a surgical procedure that joins the upper and lower eyelids together to partially or completely cover the eye. It is indicated to protect the cornea and promote healing in cases of corneal exposure from conditions like lagophthalmos, proptosis, or eyelid malposition, as well as non-healing corneal defects from issues like limbal stem cell deficiency or neurotrophic ulcers. Tarsorrhaphy can be temporary or permanent, partial or complete, and performed laterally, medially, or centrally using different suturing techniques. The goal is to safely and effectively manage corneal diseases and promote healing.

1. ENUMERATE THE INDICATIONS
AND DESCRIBE THE METHODS
OF TARSORRHAPHY
Dr. Gariyashee Lahkar

2. OUTLINE OF PRESENTATION
 INTRODUCTION
 INDICATIONS
 TYPES
 TECHNIQUES
 COMPLICATIONS
 OUTCOME
 CONCLUSION

3. INTRODUCTION

4. INTRODUCTION
 Tarsorrhaphy is a surgical procedure in which
part, or all the upper and lower eyelids are joined
together to cover the eye partially or completely.
 Main goals : Protect the cornea and ocular surface
To allow/promote corneal healing

5. INDICATIONS

6. INDICATIONS
CORNEAL
EXPOSURE
NON-HEALING
CORNEAL
DEFECTS
IN CONJUNCTION
WITH OTHER
SURGERIES

7. INDICATIONS
CORNEAL
EXPOSURE PROPTOSIS
LAGOPHTHALMOS
EYELID MALPOSITION

8. INDICATIONS
NON-
HEALING
CORNEAL
DEFECTS
LIMBAL STEM CELL
DEFICIENCY
NEUROTROPHIC
CORNEAL ULCERATION
RECALCITRANT DRY EYE

9. INDICATIONS
WITH
OTHER
SURGERIES GLOBE RECONSTRUCTION
PROSTHESIS
AMNIOTIC MEMBRANE
TRANSPLANTATION

10. INDICATIONS
CORNEAL
EXPOSURE
• LAGOPHTHALMOS (facial nerve palsies, cicatricial damage)
• PROPTOTIS (thyroid eye disease, inflammatory orbital disease, orbital tumor)
• EYELID MALPOSITION (trauma, ectropion, scaring, floppy eyelid syndrome)
• INADEQUATE BLINKING (reduced corneal sensation, severe brain injury)
NON-HEALING
CORNEAL
DEFECTS
• Neurotrophic corneal ulceration
• Limbal stem cell deficiency
• Recalcitrant dry eye
WITH OTHER
SURGERIES
• Prosthesis
• Globe reconstruction
• Amniotic membrane transplantation

11. TYPES

12. TYPES
TARSORRHAPHY
TEMPORARY PERMANENT
Based on Duration,

13. TYPES
TARSORRHAPHY
COMPLETE PARTIAL
Based on Extent,

14. According to the position of the adhesion of the palpebral fissure,
TARSORRHAPHY
LATERAL MEDIAL CENTRAL

15. TEMPORARY TARSORRHAPHY
• Temporary tarsorrhaphy is the partial occlusion of the eyelids
• Temporary measure, where desired eyelid closure is < 8 weeks
• Can be placed anywhere along the lid margins
• Use of bolsters is common in temporary tarsorrhaphy
# Bolsters can be made of plastic, or of small cotton-wool balls. They are
used to prevent the eyelid skin from tight sutures, and allow better suture
tension control to close the eyelids the desired amount.

16. TEMPORARY TARSORRHAPHY: TECHNIQUE
Suture is passed
through the
bolster
Followed by the
upper eyelid
Then the lower
eyelid
Second Bolster is
engaged
Suture is turned
around
Lower eyelid Upper Eyelid
Bolster
Suture is then
tied to complete
the tarsorrhaphy

17. TEMPORARY TARSORRHAPHY: TECHNIQUE

18. PERMANENT TARSORRHAPHY
• Permanent tarsorrhaphy involves intramarginal adhesion of upper and lower eyelids.
• It can be Lateral, Medial and Central/Pillar.
• Permanent tarsorrhaphy should be considered in the following cases:
1. When maximal therapy has failed to treat corneal exposure,
2. In cases where prolonged eyelid closure is desired
3. When the duration of time required is uncertain

19. LATERAL TARSORRHAPHY: TECHNIQUE
• Determine location and amount of tarsorrhaphy
• Infiltrate local anaesthesia
• Clamp to improve haemostasis
• Separate the anterior and the posterior lamellae
• Posterior lamellae of both eyelids are sutured together
• Anterior lamellae of both eyelids are then sutured together

20. LATERAL TARSORRHAPHY: TECHNIQUE

21. MEDIAL TARSORRHAPHY: TECHNIQUE
• Incision peripheral to the canaliculi
to the upper and lower lids
• Does not interfere with peripheral
vision

22. PILLAR TARSORRHAPHY: TECHNIQUE
• Two pillars of tarso-conjunctival
tissue
• Central area of the upper and lower
eye lid
• Sutures are tied to complete the
tarsorrhaphy

23. POST-OPERATIVE CARE

24. POST-OPERATIVE CARE
• Antibiotic ointment
• Appropriate topical lubricating drops and antibiotics
• Timely Follow up
• Avoid eye rubbing
• Avoid cosmetic application

25. COMPLICATIONS

26. COMPLICATIONS
• Bleeding
• Infection
• Swelling
• Damage to surrounding structures
• Premature separation
• Ankyloblepharon formation
• Pyogenic or suture granulomas
• Trichiasis, distichiasis
• Lid margin deformities

27. OUTCOME

28. OUTCOME
• Safe and effective procedure .
• Useful for treatment of nonhealing epithelial defects, corneal surface disease, and other
ocular and eyelid disorders.
• Overall success rate for tarsorrhaphy: 80 to 100% .
• Effects of traditional suturing techniques last from 2 to 8 weeks.
• Temporary tarsorrhaphies promote healing in 2 weeks and can be removed at that time.
• If adequate healing has not occurred and the patient requires long-term treatment, a
permanent tarsorrhaphy can be performed which can still be opened at a later date.

29. ALTERNATIVE METHODS

30. ALTERNATIVE METHODS
• Glue tarsorrhaphy:
o Cyanoacrylate glue used to temporarily occlude the eyelids
o Also known as “superglue tarsorrhaphy”
• Neurotoxin tarsorrhaphy: using Botulinum toxin type A
• Taping : temporary closure , < 24 hours
• Moisture-retaining eyewear: another temporary measure

31. CONCLUSION

32. CONCLUSION
Tarsorrhaphy is a safe and relatively simple procedure that can be used alone or in
combination with other surgical techniques.
Highly effective in the management of nonhealing epithelial defects and other corneal
surface pathology.
Noncompliant and debilitated patients who cannot reliably put in therapeutic topical
medications perhaps profit from this intervention the most.
Techniques vary, and it can be can be permanent or temporary, total or partial.
Care must be taken to avoid suture chafing the cornea epithelium and iatrogenic
trichiasis when a temporary or permanent tarsorrhaphy is constructed.