Westcott E-30440 00 Titanium Super Soft Grip Scissor, 10 cm- Grey/Yellow

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Stevens or Westcott scissors are used to dissect between the anterior and posterior lamella to a depth of 3-4 mm making sure to stay parallel to the tarsal plate. Trivedi D, McCalla M, Squires Z, Parulekar M. Use of cyanoacrylate glue for temporary tarsorrhaphy in children. Ophthalmic Plast Reconstr Surg. 2014 Jan-Feb;30(1):60-3. doi: 10.1097/IOP.0000000000000011. PMID: 24398490. Naik MN, Honavar SG, Bhaduri A, Linberg JV. Congenital horizontal tarsal kink: a single-center experience with 6 cases. Ophthalmology. 2007 Aug;114(8):1564-1568. DOI: 10.1016/j.ophtha.2006.12.001. PMID: 17367861. A #11 or #15 Bard-Parker blade is used to make an incision along the grey line of the lateral lower lid of the desired length to a depth of 2 mm. The posterior lamellae of the upper and lower lids are sutured together using 5-0 or 6-0 Vicryl suture in interrupted fashion.

Allen, R. “Pillar tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library. The mucocutaneous junction of the posterior lamella of the lower lid is excised using Westcott scissors. To retain a prosthesis, Boston Keratoprosthesis, or other device in patients with anophthalmia or after evisceration or enucleation

Surgical products

Hogeweg M, Keunen JE. Prevention of blindness in leprosy and the role of the Vision 2020 Programme. Eye. 2005: 19, 1099–1105.

silk sutures are passed through the upper eyelid at the level of the meibomian gland orifices and the eyelid is everted over a speculum. Tanenbaum M, Gossman MD, Bergin DJ, Friedman HI, Lett D, Haines P, McCord CD Jr. The tarsal pillar technique for narrowing and maintenance of the interpalpebral fissure. Ophthalmic Surg. 1992 Jun;23(6):418-25. PMID: 1513540.Allen, R. “Temporary bolster tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library. Steiner GC, Gossman MD, Tanenbaum M. Modified tarsal pillar tarsorrhaphy. American Journal of Ophthalmology. 1993 Jul;116(1):103-104. DOI: 10.1016/s0002-9394(14)71755-6. PMID: 8328528. Prior to the procedure, a full ophthalmic examination should be performed and documented. A thorough slit lamp biomicroscopic examination should document corneal pathology and the size and location of any defects or corneal ulcers. Careful examination of the palpebral conjunctiva using double eversion to look for foreign bodies or keratinization should also be performed. External examination of eyelid abnormalities, the degree of lagophthalmos, and assessment of corneal sensitivity are critical in determining what type of tarsorrhaphy is appropriate (permanent vs. temporary) and deciding on the extent of tarsorrhaphy (lateral vs. medial vs. central vs. total) to be performed. The length of tarsorrhaphy to be performed is determined by gently pinching the upper and lower eyelids together with forceps or manually to achieve desired closure. Cosar CB, Cohen EJ, Rapuano CJ, Maus M, Penne RP, Flanagan JC, Laibson PR. Tarsorrhaphy: clinical experience from a cornea practice. Cornea. 2001 Nov;20(8):787-91. doi: 10.1097/00003226-200111000-00002. PMID: 11685052. As with any surgical procedure, there is a risk of bleeding, infection, swelling, and/or damage to surrounding structures. Other risks include premature separation, the need for reoperation, ankyloblepharon formation, pyogenic or suture granulomas, trichiasis, distichiasis, skin breakdown, lid margin deformities, and premature separation. [6] Pillar tarsorrhaphies have a unique complication of ectropion. [20] Reported side effects of neurotoxin tarsorrhaphies included preseptal hemorrhage, inadvertent injury to the globe, and superior rectus under action resulting in diplopia which can last up to 9 months after injection. [18] Outcomes

The upper eyelid is prepped with Betadine solution and the desired concentration is drawn up into a 1 mL insulin or tuberculin syringe. Introduce the needle tip of a 23 to 26-gauge needle just below the superior orbital rim along the mid-pupillary plane and passed against the orbital roof for 1 to 2 cm. The desired amount of botulinum toxin is injected, and the needle and syringe are discarded appropriately. The patient should then be monitored closely for appropriate healing and resolution of ptosis with return of levator function. [18] [19] Repeat injection may be necessary. The final step is to create the drawstring, the 2 suture arms are passed through the 3rd bolster (it is commonplace to make this smaller than the other ones)Allen, R. “Lateral tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library. Donnenfeld ED, Perry HD, Nelson DB. Cyanoacrylate temporary tarsorrhaphy in the management of corneal epithelial defects. Ophthalmic Surg. 1991;22591- 593. Ellis MF, Daniell M. An evaluation of the safety and efficacy of botulinum toxin type A (BOTOX) when used to produce a protective ptosis. Clin Exp Ophthalmol. 2001;29(6):394–399. Attention is then directed to the lower eyelid where a rectangle of tarsoconjunctival tissue is excised at the eyelid margin with the #15 blade and Westcott scissors at the level of each of pillar.