The caretaker-reversible Tarsorrhaphy

Abstract

Purpose: To present a modification of the reversible tarsorrhaphy that can be opened and reclosed as necessary by caretakers and the patient.

Methods: Retrospective case series of patients who underwent the reversible tarsorrhaphy. Materials included intravenous (IV) tubing as bolsters and 4-0 polypropylene suture. The 4-0 suture is first passed through and through one end of IV tubing approximately 20 mm in length. Starting on the lateral upper lid and approximately 4 mm above the lash line, the suture is placed through the skin and into the tarsus. The suture exits through the eyelid gray line. These steps through the eyelid are repeated in the opposite direction. An air knot is tied above the upper eyelid near the base of IV tubing. A second air knot can be tied higher to provide a handle easily allowing the caretaker to close the eyelid.

Results: Included were 13 patients (ages 21-95-yeas), indications included lagophthalmos secondary to cicatricial changes from burns (2), keratouveitis (1), neurogenic palsy (3), neurotrophic ulcer (6), and cicatricial changes from skin cancer (1). There were no reported difficulties in maintaining the tarsorrhaphy by either family members or healthcare providers. The first tarsorrhaphy for each patient lasted between 3-19 weeks, with an average of 8 weeks. All were well tolerated.

Conclusions: The caretaker-reversible tarsorrhaphy can be used as a temporizing measure. The technique balances the need for ocular protection with the need for examination/treatment by health care professionals and, equally importantly, the patients and caretakers.

Keywords: Cornea; Oculoplastic surgery; Oculoplastics; Tarsorrhaphy.

Fig. 1

Materials for procedure

Fig. 2

Reversible tarsorrhaphy illustrated. Suture should exit through the eyelid grayline (Figure 2, A) then into the grayline of the opposite eyelid in a parallel position (Figure 2, B), then passed through and through the cross section of the second IV tubing bolster (Figure 2, C). These steps are repeated for the second arm of the suture near the medial aspect of the eyelid (Figure 2, D,E, F). A sliding knot is tied above the upper eyelid near base of IV tubing (Figure 2, G, H) resulting in a completed surgery (Figure 2, I)

Fig. 3

Demonstration of the tarsorrhaphy opened and closed