Temporary tarsorrhaphy is a surgical procedure where the upper and lower eyelids are partially or completely joined. This temporary procedure protects the eye’s surface, especially the cornea, from external factors or underlying conditions. It is intended for a limited duration, allowing the eye to heal before the eyelids are reopened.
What is Temporary Tarsorrhaphy?
Temporary tarsorrhaphy involves surgically connecting segments of the upper and lower eyelids. The primary goal of this technique is to reduce the exposed surface area of the eye, thereby safeguarding the cornea. This partial or complete closure helps create a more protected and moist environment for the eye.
The procedure is reversible, meaning the eyelids can be separated once the eye’s condition improves. This reversibility distinguishes it from permanent tarsorrhaphy, which involves a more lasting adhesion of the eyelids. The extent of closure can vary, from joining the outer corners of the eyelids (lateral tarsorrhaphy) to a more central or complete closure, depending on the specific needs of the eye.
Why is Temporary Tarsorrhaphy Performed?
Temporary tarsorrhaphy is performed for various medical reasons, primarily to protect the cornea and promote its healing. One common indication is severe dry eye, where insufficient tear production or rapid tear evaporation leaves the cornea vulnerable to drying and damage. By reducing the eye’s opening, the procedure helps retain moisture and prevents further desiccation.
Facial nerve paralysis, such as Bell’s palsy, often leads to lagophthalmos, an inability to fully close the eyelids. This exposes the cornea to the environment, increasing the risk of exposure keratopathy, a condition caused by corneal drying. Tarsorrhaphy provides a physical barrier, preventing corneal exposure and aiding in recovery. The procedure is also employed for non-healing corneal ulcers or abrasions, creating a shielded environment that supports the regeneration of corneal tissue. Additionally, it may be used after certain eye surgeries, like corneal transplants or orbital tumor removal, to protect the delicate surgical site during the initial healing phase.
The Procedure and Post-Operative Care
The temporary tarsorrhaphy procedure begins with the administration of a local anesthetic to numb the area around the eye. The surgeon then uses sutures to join the upper and lower eyelids, often at the outer (lateral) or central portions, depending on the required level of closure. Bolsters, which are small pieces of plastic, cotton, or tubing, may be used with the sutures to distribute tension and protect the skin from the sutures.
After the procedure, post-operative care focuses on maintaining hygiene and managing discomfort. Patients are advised to keep the surgical area clean and are prescribed antibiotic ointments or drops to prevent infection. Mild redness, swelling, or pain around the treated eye are common and resolve within a few days. Applying a cold compress can help alleviate swelling and discomfort. Patients are instructed to avoid rubbing the eye and to refrain from wearing eye makeup until cleared by their doctor.
Removal and Recovery
The removal of a temporary tarsorrhaphy occurs once the underlying eye condition has improved or healed, which can range from a few weeks to several months. The sutures are removed in a clinical setting by a healthcare professional. In some cases, if the initial healing is incomplete, the sutures may be replaced for an additional period.
After suture removal, the eye gradually returns to its normal function. Patients may experience some residual effects, such as mild discomfort or changes in vision, as the eyelids readjust. Follow-up appointments are scheduled to monitor the eye’s healing progress and to ensure proper eyelid function.