TARSORRHAPHY

In this operation adhesions are created between a
part of the lid margins with the aim to narrow down or
almost close the palpebral aperture.
It is of two types: temporary and permanent.
1. Temporary tarsorrhaphy
Indications : (i) To protect the cornea when seventh
nerve palsy is expected to recover. (ii) To assist
healing of an indolent corneal ulcer. (iii) To assist in
healing of skin-grafts of the lids in the correct position.
Surgical techniques. This can be carried out as
median or paramedian tarsorrhaphy (Fig. 14.31).
1. Incision. For paramedian tarsorrhaphy, about 5
mm long incision site is marked on the
corresponding parts of the upper and lower lid
margins, 3-mm on either side of the midline. An
incision 2-mm deep is made in the grey line on the
marked site and the marginal epithelium is then
excised taking care not to damage the ciliary line
anteriorly and the sharp lid border posteriorly.
2. Suturing. The raw surfaces thus created on the
opposing parts of the lid margins are then sutured
with double-armed 6-0 silk sutures passed through
a rubber bolster.
2. Permanent tarsorrhaphy
Indications. (i) Established cases of VII nerve palsy
where there is no chance of recovery; and (ii)
established cases of neuroparalytic keratitis with
severe loss of corneal sensations.
Technique. It is performed at the lateral canthus to
create permanent adhesions. The eyelids are
overlapped after excising a triangular flap of skin and
orbicularis from the lower lid and corresponding
triangular tarso-conjunctival flap from the upper lid.