Tarsorrhaphy, a surgical procedure wherein the eyelids are partially sewn together to narrow the eyelid opening, is rarely performed but plays a unique and important role in the treatment of certain eyelid and corneal conditions. The procedure is performed on the corner of the eyelid opening. Michael Neimkin, M.D. at the Ophthalmic Plastic and Cosmetic Surgery Center in Atlanta, GA, performs it on patients suffering from conditions that impair the eyelid’s ability to protect the eyes and facilitate blinking. These conditions place the cornea at risk of drying. The surgery’s main goal is to keep the eyelids partially shut, allowing moisture to be retained in the affected eye.

Candidates for Tarsorrhaphy

Tarsorrhaphy is recommended for patients who suffer from severe ocular surface disorders, corneal epithelial disorders, and conditions that cause ocular exposure. Some examples of these conditions include:

  • Bell’s Palsy, a nerve disorder that causes eyelid paralysis or eyelid weakness.
  • Myasthenia gravis, a condition that weakens the facial muscles including the eyelids.
  • Stroke – Stroke patients may have difficulty controlling the movement of their eyelids.
  • Brain injuries – Brain injuries, which can be caused by a variety of factors, such as stroke or accidental trauma, can make the process of controlling the blinking motion of the eyes extremely challenging for patients.
  • Sjogren’s syndrome, which causes a reduced flow of tears.
  • Dendritic ulcers in the cornea.
  • Exophthalmos or proptosis, a condition wherein the eyes stick out or protrude from their sockets, placing them at risk of drying. This may also present as a symptom of other diseases, such as eye tumors and Graves’ disease.
  • Enophthalmos, a disorder wherein the eye is positioned too far back in its socket, rendering normal eyelid function insufficient in protecting the cornea.
  • Cicatricial or scarring – Scarring, which commonly occurs as a result of burns injuries, can also damage the eyelids and keep them from functioning properly.

About the Procedure

Dr. Neimkin carefully stitches the corners of the eyelids together to narrow the opening of the eye. This keeps the cornea from being overly exposed, thus giving it vital protection. Tarsorrhaphy keeps the eyes lubricated by reducing its exposure to the air.

Tarsorrhaphy is usually considered as a last resort when other efforts to retain moisture in the cornea have failed. Dr. Neimkin typically prescribes eye drops and the use of contact lenses first to keep the cornea moist and to protect them from direct contact with external elements.
The procedure is not a treatment in and of itself. It is usually followed by other procedures that address underlying conditions affecting the eyelids or the cornea. Once the underlying condition has been treated, the effects of tarsorrhaphy can easily be reversed. There are now several methods used to perform tarsorrhaphy.

These include the use of:

  • Cyanoacrylate glue
  • Botulinum toxin
  • Suturing techniques
  • Pressure patching
  • Drawstring techniques

When the conventional suturing method is used, its effects last between two and eight weeks, allowing Dr. Neimkin sufficient time to examine and treat the underlying condition. After 8 weeks, all sutures will lose their original tension. If the patient’s condition requires long-term effects, a permanent tarsorrhaphy can be performed, in which a part of the lid margin undergoes debridement to keep the lids sealed or narrowed.
Regardless of which technique is used, tarsorrhaphy is a quick, outpatient procedure that requires the application of local anesthesia to the upper portion of the face.

Each patient is unique; therefore, results will vary.

Don’t risk the long term and serious effects of any of the conditions outlined above. Complete our contact form today to schedule a consultation with Dr. Neimkin. At the Ophthalmic Plastic and Cosmetic Surgery Center, Dr. Neimkin and the staff take pride in only offering patients the highest level of care in a family-like environment. Our office serves patients in the metro Atlanta, GA area including the surrounding communities of Sandy Springs, Buckhead, Dunwoody and Roswell. We look forward to helping you soon.

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