The principle is to join the upper and lower lids laterally to reduce the palpebral aperture horizontally and improve the protection of the cornea.
The technique is as follows:
a) Temporary tarsorrhaphy (Figure 7.1a).
• Excise the lid margin tissues of the upper and lower lid laterally for the length of the intended tarsorrhaphy.
• Insert two vertical mattress sutures of 4/0 silk - as shown in the diagram. Tie the sutures over bolsters.
• Remove the sutures at one week.
b) Permanent tarsorrhaphy (Figure 7.1b).
• Make an incision along the grey line of the upper lid and lower lid laterally for the length of the intended tarsorrhaphy. Deepen the incisions, staying on the anterior tarsal surfaces for the full height of the upper and lower lid tarsal plates.
• Make a vertical cut through the full height of the upper and lower lid tarsal plates at the medial ends of the grey line incisions. This creates triangles of tarsal plate laterally in the upper and lower lids.
• Excise the triangle of the tarsal plate in the lower lid.
• Insert a double armed 4/0 suture through the tip of the triangle of the tarsal plate in the upper lid. Pass both needles through the apex of the bare area in the posterior aspect of the lower lid and through to the skin. Tie the sutures over a bolster.
• Close the skin of the lid margin with vertical mattress sutures from above the upper lid lashes to below the lower lid lashes. This ensures the lashes do not point posteriorly to abrade the cornea.
• Temporary tarsorrhaphy - the tarsorrhaphy often breaks down in places as soon as the sutures are removed.
• Permanent tarsorrhaphy - a fistula which drains tears may appear at the lateral canthus if the canthal skin is not carefully closed.
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