Neurotrophic corneal ulceration (CN V deficit, herpes simplex virus (HSV) or varicella zoster virus (VZV) keratitis) [1] silk sutures are passed through the upper eyelid at the level of the meibomian gland orifices and the eyelid is everted over a speculum. A #11 or #15 Bard-Parker blade is used to make an incision along the grey line of the lateral lower lid of the desired length to a depth of 2 mm.

The upper eyelid is prepped with Betadine solution and the desired concentration is drawn up into a 1 mL insulin or tuberculin syringe. Introduce the needle tip of a 23 to 26-gauge needle just below the superior orbital rim along the mid-pupillary plane and passed against the orbital roof for 1 to 2 cm. The desired amount of botulinum toxin is injected, and the needle and syringe are discarded appropriately. The patient should then be monitored closely for appropriate healing and resolution of ptosis with return of levator function. [18] [19] Repeat injection may be necessary. Made in premium quality stainless steel with satin finish to reduce glare. The instrument can be sterilized and reused. Specialty The 4-0 silk everting sutures are removed, and the eyelids are inspected to ensure appropriate closure. [3] [14] Proptotic exposure secondary to thyroid eye disease or other inflammatory orbital disease, and orbital tumors [1] The mucocutaneous junction of the posterior lamella of the lower lid is excised using Westcott scissors.

Scissor - Iris, Straight, Blunt Blades, Length 10cm

Hogeweg M, Keunen JE. Prevention of blindness in leprosy and the role of the Vision 2020 Programme. Eye. 2005: 19, 1099–1105.

Steiner GC, Gossman MD, Tanenbaum M. Modified tarsal pillar tarsorrhaphy. American Journal of Ophthalmology. 1993 Jul;116(1):103-104. DOI: 10.1016/s0002-9394(14)71755-6. PMID: 8328528. Stevens or Westcott scissors are used to dissect between the anterior and posterior lamella to a depth of 3-4 mm making sure to stay parallel to the tarsal plate.Tarsorrhaphy is a safe and relatively simple procedure in which part, or all the upper and lower eyelids are joined together to cover the eye partially or completely. Tarsorrhaphies are highly effective in the management of nonhealing epithelial defects and other corneal surface pathology by creating a more hospitable environment for corneal healing. [1] Tarsorrhaphies can be permanent or temporary, total or partial, and can be further classified into short duration tarsorrhaphies without sutures, temporary suture tarsorrhaphies, permanent suture tarsorrhaphies, and more extensive tarsorrhaphies that involve mobilization of skin or tarsal plate flaps. [2] The temporary suture tarsorrhaphy can be placed anywhere along the lid margins. If inspection of the cornea at intervals is desired, a drawstring tarsorrhaphy technique can be utilized. The suture is then tied over the bolster to complete the tarsorrhaphy. The suture should be snug to prevent incomplete lid opposition when intraoperative edema resolves. To retain a prosthesis, Boston Keratoprosthesis, or other device in patients with anophthalmia or after evisceration or enucleation If the eye needs to be opened the smaller bolster is separated from the larger lower eyelid bolster, which allows the eyelid to be examined or to receive treatment

Tzelikis PF, Diniz CM, Tanure MA, Trindade FC. Tarsorrafia: aplicações em um Serviço de Córnea [Tarsorrhaphy: applications in a Cornea Service]. Arq Bras Oftalmol. 2005 Jan-Feb;68(1):103-7. Portuguese. doi: 10.1590/s0004-27492005000100019. Epub 2005 Mar 30. PMID: 15824813. Khairy H. Botulinum toxin A-induced ptosis: A safe and effective alternative to surgical tarsorrhaphy for corneal protection. Journal of the Egyptian Ophthalmological Society. 2014;107(1):20-22. doi:10.4103/2090-0686.134937. Naik MN, Honavar SG, Bhaduri A, Linberg JV. Congenital horizontal tarsal kink: a single-center experience with 6 cases. Ophthalmology. 2007 Aug;114(8):1564-1568. DOI: 10.1016/j.ophtha.2006.12.001. PMID: 17367861. Ellis MF, Daniell M. An evaluation of the safety and efficacy of botulinum toxin type A (BOTOX) when used to produce a protective ptosis. Clin Exp Ophthalmol. 2001;29(6):394–399. Allen, R. “Pillar tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library.

Especially includes narrow blades which increase precision. Moreover, the instrument has curved blades that contort to the surface of the eye for increased accuracy.

The needle is then turned around and passed 3-4 mm below the lower lid skin, through the lid margin and retrieved from the meibomian gland orifices. The anterior lamella of the lower lid is then sutured to the anterior lamella of the upper lid using absorbable or permanent 5-0 to 6-0 suture in an interrupted fashion. [1] [13] Lagophthalmos due to facial nerve palsies (neurogenic exposure keratopathy), cicatricial damage to the eyelids, anorexia nervosa, leprosy, Ramsay Hunt Syndrome Type 2, orbital tumors, and thyroid eye disease [1] [7] [8] [9] Illustration of a Temporary Bolster Tarsorrhaphy step-by-step approach. Image drawn by Fabliha A. Mukit using an iPad and the Procreate app. Temporary Bolster Tarsorrhaphy Technique A medial tarsorrhaphy is another useful technique when applicable. This technique is modified to avoid damage to the canaliculi and involves making a V-shaped incision peripheral to the canaliculi to the upper and lower lids. The medial tarsorrhaphy is advantageous in that it does not interfere with peripheral vision.Allen, R. “Lateral tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library.