Tarsorrhaphy is a rare procedure in which the eyelids are partially sewn together to narrow the opening.
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.
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.
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.
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.
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.
Tarsorrhaphy carries few risks. Complications may include minor eyelid swelling and superficial infection.
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.
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.
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?