Tarsorrhaphy





Definition

Tarsorrhaphy is a rare procedure in which the eyelids are partially sewn together to narrow the opening.


Purpose

The eye needs the lid for protection. It also needs tears and periodic blinking to cleanse it and keep it moist. There are many conditions that impair these functions and threaten the eye, specifically the cornea, with drying. Sewing the eyelids partially together helps protect the eye until the underlying condition can be corrected.

A partial list of the conditions that can require tarsorrhaphy includes:

  • Paralysis or weakness of the eyelids so that they cannot close or blink adequately. Bell's palsy is a nerve condition that weakens the muscles of the face, including the eyelids. It is usually temporary. Myasthenia gravis also weakens facial muscles, but it is usually treatable. A stroke can also weaken eyelids so that they do not close.
  • Exophthalmos (eyes bulging out of their sockets) occurs with Graves' disease of the thyroid, and with tumors behind the eyes. If the eyes bulge out too far, the lids cannot close over them.
  • Enophthalmos is a condition in which the eye falls back into the socket, making the eyelid ineffective.
  • Several eye and corneal diseases cause swelling of the cornea, and require temporary added protection until the condition resolves.
  • Sjögren's syndrome reduces tear flow to the point where it can endanger the cornea.
  • Dendritic ulcers of the cornea caused by viruses may need to be covered with the eyelid while they heal.

Demographics

People of all ages can suffer from paralysis or corneal diseases that may benefit from tarsorrhaphy. For that reason, physicians can perform tarsorrhaphy on patients of any age. However, it is viewed as a last alternative for many patients, and is not indicated until after other treatments (e.g., patching and eye ointments) have been attempted.


Description

Stitches are carefully placed at the corners of the eyelid opening (palpebral fissure) to narrow it. This provides the eye with improved lubrication and less air exposure. Eyeball motion can help bathe the cornea in tears when it rolls up under the lid. The outpatient procedure is done under local anesthetic.


Diagnosis/Preparation

The use of eye drops and contact lenses to moisten and protect the eyes must be considered before tarsorrhaphy is performed. Tarsorrhaphy is a minor procedure done under local anesthesia. Special preparation is not necessary.


Aftercare

Patients should avoid rubbing the eye and refrain from wearing make-up until given permission from the physician. Driving should be restricted until approval from the ophthalmologist.

Pathways in the home should be cleared of obstacles, and patients should be aware of peripheral vision loss. They will need to compensate by turning their head fully when looking at an object.

An analgesic may be used to ease pain, but severe pain is not normal, and the physician must be alerted. Sutures will be removed in two weeks.

Eye drops or ointment may still be needed to preserve the cornea or treat accompanying disease.


Risks

Tarsorrhaphy carries few risks. Complications may include minor eyelid swelling and superficial infection.


Normal results

The procedure succeeds in protecting the eye and returning moisture to dry eyes.


Morbidity and mortality rates

This is a safe procedure. Only superficial infections have been reported.


Alternatives

Eye drops and contact lenses are widely used to treat conditions that once warranted tarsorrhaphy. The procedure is now considered a last option for treatment.

Resources

BOOKS

Cassel, M.D., H. Gary, Michael D. Billig, O.D.,and Harry G. Randall, M.D. The Eye Book: A Complete Guide to Eye Disorders and Health. Baltimore, MD: Johns Hopkins University Press, 1998.

Daly, Stephen, ed. Everything You Need to Know About Medical Treatments. Springhouse, PA: Springhouse Corp., 1996.

Sardegna, Jill Otis, et al. The Encyclopedia of Blindness and Vision Impairment, 2nd ed. New York: Facts on File Inc., 2002.


J. Ricker Polsdorfer, M.D. Mary Bekker

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Ophthalmologists perform the procedure on an outpatient basis in a hospital, or sometimes in their offices.

QUESTIONS TO ASK THE DOCTOR



  • How long will will the eyes be closed with sutures?
  • Will it be painful?
  • Will the condition be remedied after the procedure?

User Contributions:

vithiya
Report this comment as inappropriate
Aug 16, 2009 @ 9:21 pm
thank you so much for the article. it was very useful and easily understandable
Report this comment as inappropriate
Apr 2, 2010 @ 8:20 pm
what type have patient can have tarsrraphy reversed i have had it done recently after complications having a cataract removed but my bells palsy was 20yrs ago and have had no problem with the eye until the cataract was removed and i developed herpes on the cornia but valtrex cured that tempararily can you help
Report this comment as inappropriate
Apr 2, 2010 @ 8:20 pm
what type have patient can have tarsrraphy reversed i have had it done recently after complications having a cataract removed but my bells palsy was 20yrs ago and have had no problem with the eye until the cataract was removed and i developed herpes on the cornia but valtrex cured that tempararily can you help
dr kavita prasad
Report this comment as inappropriate
Oct 18, 2010 @ 11:11 am
The information given is very valuable but if described about different types of tarsorrhaphy & how it is performed in short then it will become more informative.Please do send me the required information to my email if possible.
sarah
Report this comment as inappropriate
Nov 29, 2010 @ 4:16 pm
sent from Downers Grove Public Library re Lateral Tarsorrhaphy
Nellda Conwill
Report this comment as inappropriate
Apr 15, 2011 @ 12:12 pm
I came down with shingles on my left side of scalp,forehead,and left eyelids which later involved my nose. This was Nov. 12 2009. My eyesight was ok until May or June 2010 when I could only see light or a hand waving in front of me. My ophthalmologist sent me to a specialist in Birmingham, AL where they did the tarsorrhaphy proceedure. January this year, my ophthamologist opened my eyelids on one side. My eyesight was much improved then to 20/60. ON Apr.14th,He opened half of the other closed side with plans to finish opening the eye in 3 more months. This has been a long uncomfortable year but I'm pleased that my sight has improved so much. My question is: Is this not an unusual long time for the eyelids to stay sutured? I have done everything that was prescribed to get over this. Thank you for a reply.
Report this comment as inappropriate
Nov 13, 2011 @ 12:12 pm
My doctor is going to perform this surgey on me next week. My eye problem is a direct result of shingles in the eye. I have used all of the steriod and moisturizing eye drops. I had the contact lense put in to protect the eye. I have also worn an eye patch that seems to force me to keep my eyelid closed. Is this procedure more effective than everything else I have tried? At this point I will continue to try anything. I have been suffering from this for ten months. There are days when I think my eye is beginning to heal and I can see better, the next day I can hardly see anything and I feel a terrible burning in the corner of my eye. From my eye upward over my forehead is a deadening feeling. Is this the nerve endings flaring up or the shingles?? Is there any hope for my eyesight return to normal after ten months of suffering? Any information is welcomed. Thank you, Ms. B in Oklahoma.
Pam
Report this comment as inappropriate
Mar 20, 2012 @ 11:11 am
I had a acoustic neuroma removed last year that left me with facial palsey I could not close my eye and after trying lubricants and even botox it was decided to do tarsorrhaphy, my eye has been like this form the past 8 months and am due back at hospital on 01/05/12 but my big worry is how they are going to open it.
Lucy
Report this comment as inappropriate
May 21, 2012 @ 2:14 pm
I had an acoustic neuroma rmoved last November that has left me with facial palsey. I had to have a gold weight put in my eyelid in Feb so that I can close my eye. That has worked well except that I still cannot blink my eye. My eye is still very dry. I have been using drops constantly since my surgery. However according to my opthamologist I still have a couple of small dry spots on my eye which is why I still feel like I have something in my eye all the time and it is always red and irritated. Doctor is suggesting I have the tarsorraphy procedure done until my facial palsey returns back to normal...which doctors are fully expecting it to. I really don't want to do this because I don't know how odd my eye will look afterwards. However, I don't want to lose any more eyesight either. They told me it can be reversed. Is this procedure going to make that much difference?
Katherine
Report this comment as inappropriate
May 31, 2012 @ 7:07 am
I had a Tarsorrhaphy done 2 months ago because of Bells Palsy, my face has improved and the Nurologist has told me that I may be able to have it reversed soon, I was woundering if anyone has had it reversed yet and how it went? was it more painful having it reversed? my eye lids were cut so that when it was stiched they joined and when the stiches were taken out 11 days later the eyelid had fused together, so Im wounderng do they just cut it open then sew along the top and bottom eye lid or do they quarterise it so the skin seals and doesent bleed? I really need more info if anyone can help! thanks.
Report this comment as inappropriate
Jul 20, 2012 @ 2:14 pm
Hi Lucy I'm having my tarsorrhapy reversed on 15th August and it will be 13 months my eyelids have been fused together. It was so comfortable after the redness and soreness and it was quite a relief to have it done. The biggest problem I've had is my eye has dropped down through weakness of my eye muscle not being used and have got to have an operation on my eyeball to stitch it back in place but can't have that done until January if you want to email me about the reversal after I've had it done my email address is pam.james3@ntlworld.com
Siobhan
Report this comment as inappropriate
Jul 25, 2012 @ 3:15 pm
Hiya All,

I was wondering if someone can help me?

I had lateral tarsorrhapy done a couple of days ago and I was hoping someone would be able to tell me how long I would need to wait to have it done again? Reason I am asking is because the top of my eye still shows and I would like to have the eyelid lowered a bit more to cover the area, in order to make my eyes look as normal as they can.

Someones opinoin would be much appreciated.
Siobhan
Report this comment as inappropriate
Jul 25, 2012 @ 3:15 pm
Hiya All,

I was wondering if someone can help me?

I had lateral tarsorrhapy done a couple of days ago and I was hoping someone would be able to tell me how long I would need to wait to have it done again? Reason I am asking is because the top of my eye still shows and I would like to have the eyelid lowered a bit more to cover the area, in order to make my eyes look as normal as they can.

Someones opinoin would be much appreciated.
imtiyazbinmuhammad
Report this comment as inappropriate
Aug 7, 2012 @ 12:00 am
as n. undergraduate(pre.final mbbs) it was helpfull to add my knowledge.
Report this comment as inappropriate
Aug 28, 2012 @ 1:01 am
Hi,everybody,
can anyone help me? I have a retraction of my eye lids & I feel the need of tarsorrhapy,but don't know a useful address.Can anyone provide me with an adress of a cheaper hospital or clinic ?
Your help would be much appreciated.
Viswamithra
Report this comment as inappropriate
Aug 31, 2012 @ 9:21 pm
This is very informative. Pls send details about types of tarsorrhaphy,premanent, temporary,median , lateral etc in detail.
Jan
Report this comment as inappropriate
Sep 4, 2012 @ 3:15 pm
I had vitreous surgery, removed scar tissue from retina, long-time diabetes. Retina ok, but cornea is still not fully healed; have been wearing bandage contact; now dr. wants to do tasorraphy to speed healing. I am very confused about what to expect. How long should healing take?
Jan
Report this comment as inappropriate
Sep 5, 2012 @ 11:11 am
I had vitreous surgery, removed scar tissue from retina, long-time diabetes. Retina ok, but cornea is still not fully healed; have been wearing bandage contact; now dr. wants to do tasorraphy to speed healing. I am very confused about what to expect. How long should healing take?
Jan
Report this comment as inappropriate
Sep 5, 2012 @ 4:16 pm
I had vitreous surgery, removed scar tissue from retina, long-time diabetes. Retina ok, but cornea is still not fully healed; have been wearing bandage contact; now dr. wants to do tasorraphy to speed healing. I am very confused about what to expect. How long should healing take?
TANVIR
Report this comment as inappropriate
Oct 5, 2012 @ 9:09 am
GOOD ATTEMPT TO TEACH.THANK YOU VERY MUCH.I AM JUST GOING TO DO TARSORRHAPHY IN A PATIENT HAVING BELLS PALSY,FOR WHOME I HAVE ALREADY TRIED BANDAGE CONTACT LENSE WITHOUT DESIRED EFECTS.
Afra
Report this comment as inappropriate
Nov 19, 2012 @ 10:10 am
My 81 years old dad has had bells palsy since 5 months ago, in his left part of the face, not able to blink. After these 5 months his face is much much better, unfortunately the ability of blinking has not come back completely yet. So the doctors are deciding to do the tarsorrhaphy operation on his eye to protect it from dryness. The question is: in the case of complete blinking in future is it possible to re-open the eye?
Lisa McClelland
Report this comment as inappropriate
Jul 22, 2013 @ 6:06 am
My dad had this procedure done two weeks ago due to Bell's Palsy. The specialist informed him that he may have a little bleeding from his eye for a couple of days. This did occur as the doctor said. On the paperwork my father was given it stated that if bleeding occurred after this to contact the doctor immediately. On Saturday, the 11th day post surgery the eye started bleeding again. The specialist won't be available to speak to until Friday of this week. My dad is 81 years old and has type 2 diabetes. Can you please explain to me what this bleeding could represent?
Thankyou.
Margaret
Report this comment as inappropriate
Feb 9, 2014 @ 10:10 am
When a tarsorrhaphy is done to one eye does it leave an obvious difference in shape to the other eye? I would also like to know if a tarsorrphaphy is the better option compared to a platinum coil inserted into the upper lid.

Comment about this article, ask questions, or add new information about this topic:

CAPTCHA


Tarsorrhaphy forum