What is tarsorrhaphy?
Tarsorrhaphy is a surgical procedure in which the upper and lower eyelids are joined together at the outer corner, inner corner, or across a portion of the eyelid opening to reduce the amount of exposed ocular surface. By narrowing or closing the space between the eyelids, tarsorrhaphy shields the cornea from dryness, abrasion, and the long-term damage that results when the eye cannot be adequately protected.
The cornea depends on the eyelids to maintain a stable tear film, distribute moisture with each blink, and provide a physical barrier against the environment. When the eyelids are unable to fulfill this role, whether due to facial nerve palsy, eyelid retraction, severe dry eye, or another condition, the cornea is left exposed and vulnerable. Without adequate protection, corneal exposure can progress from dryness and irritation to abrasion, ulceration, infection, and permanent vision loss.
Tarsorrhaphy is one of the most reliable and time-tested eyelid closure surgeries available for corneal protection. It can be performed as a temporary measure while an underlying condition resolves, or as a permanent solution when long-term corneal protection is required.
Who needs tarsorrhaphy?
Tarsorrhaphy is recommended when the cornea cannot be adequately protected by conservative measures alone and the risk of corneal damage is significant. Common indications include:
- Facial nerve palsy that prevents the eyelid from closing fully, leaving the cornea exposed
- Severe eyelid retraction that cannot be immediately corrected surgically and is causing corneal exposure
- Neurotrophic keratopathy — a condition in which the cornea loses sensation and becomes vulnerable to breakdown without adequate eyelid protection
- Severe dry eye disease that has not responded to other treatments and is resulting in corneal surface damage
- Proptosis from thyroid eye disease or orbital tumors that prevents adequate eyelid closure
- Following certain eye surgeries where temporary corneal protection is required during healing
- Incomplete eyelid closure from any cause that is resulting in corneal exposure damage
What should I expect during tarsorrhaphy?
Prior to surgery, you will meet with your oculofacial plastic surgeon for a comprehensive evaluation. During this appointment, your surgeon will:
- Assess the degree of lagophthalmos and corneal exposure
- Examine the cornea for existing surface damage including dryness, abrasion, or ulceration
- Evaluate the underlying cause of inadequate eyelid closure
- Determine whether a temporary or permanent tarsorrhaphy is most appropriate, and the optimal location and extent of the closure
Tarsorrhaphy is performed as an outpatient procedure under local anesthesia, and patients go home the same day. The procedure involves suturing the upper and lower eyelid margins together at the desired location to reduce the size of the eyelid opening. The extent of the closure is carefully planned to provide adequate corneal protection while preserving as much of the visual field as possible.
There are two primary types of tarsorrhaphy
Temporary tarsorrhaphy is performed when corneal protection is needed for a defined period while an underlying condition is expected to resolve. Temporary tarsorrhaphy uses sutures placed through the eyelid margins that can be removed once adequate eyelid closure has been restored. This approach avoids permanent changes to the eyelid and allows full restoration of the eyelid opening once the sutures are taken out.
Permanent tarsorrhaphy is performed when long-term or lifelong corneal protection is required and the underlying cause of lagophthalmos is not expected to resolve. In permanent tarsorrhaphy, the eyelid margins are joined by removing a small strip of tissue from the opposing lid margins and suturing them together so that they heal as a single fused edge. The resulting closure is durable and does not require ongoing maintenance.
In both cases, the location of the closure, whether at the outer corner, inner corner, or centrally, is determined based on where corneal exposure is most significant and how much of the visual axis needs to remain open.
What should I expect after tarsorrhaphy?
Recovery from tarsorrhaphy is generally straightforward. Most patients are able to return to light daily activities within a few days of the procedure, with full healing of the eyelid margin taking one to two weeks.
In the first several days following surgery, it is normal to experience:
- Mild swelling and bruising at the outer or inner corner of the eye where the closure was performed
- Mild discomfort or a pulling sensation along the eyelid margin
- A narrowed field of vision on the treated side as the eye adjusts to the reduced eyelid opening
- Temporary changes in tear drainage or watery eyes as the eyelid heals
For temporary tarsorrhaphy, sutures are removed once the underlying cause of lagophthalmos has resolved and adequate eyelid closure has been restored. The timing of removal varies depending on the clinical situation and is determined by your surgeon based on ongoing evaluation of corneal health and eyelid function.
What are the risks of tarsorrhaphy?
As with any surgical procedure, there are potential risks to be aware of:
- Infection at the closure site
- Scarring or irregularity along the eyelid margin
- Cheese-wiring — a complication in which sutures gradually cut through the eyelid margin tissue, particularly with temporary tarsorrhaphy
- Asymmetry or cosmetic changes to the appearance of the eye
- Reduced visual field on the treated side due to narrowing of the eyelid opening
- Incomplete corneal protection if the extent of the closure is insufficient
- Reopening of the closure — more common with temporary tarsorrhaphy if sutures loosen prematurely
- Need for revision or repeat tarsorrhaphy if the initial closure does not provide adequate protection
- For permanent tarsorrhaphy, irreversible changes to the eyelid opening that may require surgical reversal if the underlying condition resolves unexpectedly
Tarsorrhaphy is a straightforward, reliable procedure that provides the corneal protection the eye needs while a more definitive solution is pursued or as a long-term measure when one is required. The oculofacial plastic surgeons at The Iowa Clinic will evaluate your eyelid function and corneal health and determine whether tarsorrhaphy is the right option for your situation. Call 515.875.9480 to schedule an appointment.