The tarsal strip procedure is a surgical technique used to address specific issues affecting the eyelids, particularly the lower eyelid. It involves modifying and repositioning a segment of the eyelid’s supportive tissue to restore its proper tension and alignment. This procedure is a common approach in oculoplastic surgery, aiming to improve both the function and appearance of the eyelid.
Understanding the Tarsal Strip Procedure
The eyelid’s structure includes a firm, fibrous plate called the tarsus, which provides shape and support. The tarsal strip procedure involves creating a segment of this tarsal plate, often from the lateral (outer) portion of the eyelid. This strip is then reattached to the periosteum, the connective tissue covering the bone of the orbital rim, specifically the lateral orbital wall.
This reattachment effectively tightens the eyelid horizontally, helping to restore its natural position against the eyeball. The technique increases the horizontal tension of the eyelid and adjusts the level of the lateral canthus, the outer corner where the upper and lower eyelids meet. This precise repositioning helps resolve issues caused by eyelid laxity or malposition.
Conditions Addressed by Tarsal Strip Surgery
Tarsal strip surgery is frequently performed to correct eyelid malpositions, such as ectropion and entropion. Ectropion occurs when the eyelid turns outward, pulling away from the eye, which can lead to excessive tearing, dryness, and exposure of the conjunctiva. Entropion, conversely, is a condition where the eyelid turns inward, causing the eyelashes to rub against the cornea, leading to irritation and potential corneal damage.
The procedure is also effective for general eyelid laxity, a common issue where the eyelid loses its firmness and sags. This laxity can result from a weakening of the lateral and medial canthal tendons. By tightening the eyelid and re-securing it to the orbital bone, the tarsal strip procedure directly addresses these structural deficiencies, correcting the malposition and improving eyelid function.
The Surgical Process
The tarsal strip procedure is typically performed in an outpatient setting, often under local anesthesia with or without sedation. The operation itself usually takes about 45 minutes for each eye.
The general steps involve making a small incision at the outer corner of the eye and then detaching a portion of the lateral canthal tendon. The eyelid is carefully separated into its anterior and posterior layers. A strip is then fashioned from the posterior layer. This prepared tarsal strip is then sutured to the periosteum of the lateral orbital wall, adjusting the tension and height of the eyelid. Finally, the skin and muscle are repositioned and closed with sutures.
Recovery and Outcomes
Following tarsal strip surgery, patients can expect some swelling, bruising, and tenderness around the eyelids, which typically subsides within seven to ten days. Cold compresses applied for the first few days can help reduce swelling and discomfort. Sutures on the skin are usually removed after three to seven days, while deeper sutures may dissolve or remain for several weeks.
Patients are generally advised to use antibiotic eye drops or ointment for about a week to prevent infection. Most individuals feel comfortable returning to public activities within two weeks, though some minor swelling might persist for a longer period. The procedure aims to achieve an immediate and noticeable improvement in eyelid position, providing better comfort and protection for the eye. While the results are often long-lasting, the natural aging process can cause some loosening over time.