Tarsorrhaphy is a non-invasive surgical procedure performed to hold the eyelids partially closed. A patient who cannot close one eye because of facial nerve paralysis or extreme swelling due to infection may require the operation to help protect his or her cornea. When the eyelids cannot shut on their own, the eye is subjected to excessive dryness and irritation. Tarsorrhaphy and follow-up maintenance care with moistening eye drops and medications provides a temporary solution. The procedure can usually be performed in about half an hour in an outpatient setting.
Patients may lose their ability to close their eyes if they experience strokes, Bell's palsy, or another form of nerve paralysis. A puncture wound or cut on the cornea that becomes infected can result in major swelling, causing the eye to bulge and making it difficult or impossible to blink. Before considering tarsorrhaphy as a form of treatment for such conditions, doctors usually try medications, protective contact lenses, eye patches, and other nonsurgical techniques. Operations are only necessary in the most serious cases.
Before a tarsorrhaphy procedure, the patient is given an injection of a localized anesthetic, most commonly lidocaine, into his or her eyelids. The eye surgeon frequently applies moisturizing drops to the exposed cornea and sterilizes the corners of the eyelids, called the palpebral fissures. Three to ten precision stitches are used in each fissure to partially close the eye. After the sutures are in place, the surgeon applies an antibiotic ointment and a temporary bandage or patch to promote fast healing. A topical or oral anti-inflammatory medication may be prescribed to help with pain and swelling.
The patient can usually remove the patch two or three days after undergoing tarsorrhaphy. Central vision is typically left intact, but peripheral vision may be blurry or partially obstructed by the stitches. It is important for the patient to keep applying eye drops regularly so the part of the eye still exposed gets enough moisture.
An ophthalmologist can determine when it is safe to take the stitches out based on the original reason for surgery and the quality of recovery. Most patients who have temporary palsy or infections regain their ability to blink in less than two weeks, while individuals with more serious handicaps might need to keep their stitches for several months. The procedure to remove the sutures is straightforward and does not usually require special aftercare. Patients who are able to blink on their own generally recover their peripheral vision.