There are many options for restoring eyelid closure in patients with facial paralysis. One treatment option, though not as common as it once was, is known as tarsorrhaphy. Tarsorrhaphy is a surgical procedure in which the eyelids are sewn together partially in order to decrease the size of the opening. Babak Azizzadeh, MD, FACS and the team of experts at the Facial Paralysis Institute would be happy to carefully examine your particular condition to determine the best treatment option for your incomplete eyelid closure as a result of facial paralysis or Bell’s palsy.
What is Tarsorrhaphy?
Tarsorrhaphy is a procedure that involves partially sewing the eyelids together to narrow the eye opening. This procedure is used to help protect the eye from foreign objects and from painful drying in patients with full or partial facial paralysis that has affected eyelid closure. The procedure involves placing stitches at the corners of the eyelid opening in order to narrow the opening and allow the eye to stay better lubricated and protected from injury. It may be necessary to continue using eye drops and ointments to keep the eye appropriately lubricated, and in many cases, drops and contact lenses are sufficient enough to prevent the need for tarsorrhaphy altogether.
Other options for correcting difficulties relating to eyelid closure include the following procedures:
- Gold Weights – This procedure improves eyelid closure, which enhances protection for the delicate front surface of the eye. There will be a visible bulge at the site of implantation, but every effort is made to place the weights in an inconspicuous spot that follow the natural contours of the upper eyelids.
- Platinum Chains – The chains being composed of platinum, a higher density metal compared to gold, means a smaller implant can achieve the same weight and goal of eyelid closure. As a result, the chains provide the least apparent support for normal eyelid closure in patients.
- Eyelid Springs – This relatively simple approach restores eyelid closure without any conscious effort on the part of the patient. Compared to other procedures (i.e., gold weights and platinum chains), springs provide the simplest and most effective eyelid movement.
Who Should Undergo Tarsorrhaphy
While a valuable and efficient surgical procedure, tarsorrhaphy is usually regarded as a last ditch effort when other measures to retain moisture in the cornea have been unsuccessful. Tarsorrhaphy is recommended for patients who suffer from disorders leading to inadequate eyelid closure, poor or inadequate blinking, corneal disorders, and other conditions that cause prolonged exposure of the delicate front surface of the eye. Some examples of these conditions include:
- Bell’s palsy, myasthenia gravis, and strokes can cause weakness or paralysis of the muscles controlling the eyelids, resulting in adequate eyelid closure.
- Traumatic brain injuries or prolonged stays in the Intensive Care Unit (ICU) can lead to poor or inadequate blinking.
- Sjogren’s syndrome, an autoimmune disorder, decreases the production of tears, which could cause dangerous drying of the cornea.
- Ulcers in the cornea, which are commonly of viral origin, that are slowly healing can be encouraged to heal with tarsorrhaphy.
- Graves’ disease (a thyroid disorder) and tumors located behind the eyes can cause the eyes to bulge or protrude out of their sockets. A condition called exophthalmos that can cause inadequate eyelid closure, placing the cornea at risk for drying.
- Enophthalmos, a disorder in which the eye falls back into the socket, rendering the eyelid ineffective.
- Scarring, which commonly occur as a result of burns or caustic injuries, can also negatively affect eyelid function, increasing the risk of corneal injury.
In addition, tarsorrhaphy can also be utilized to prevent swelling of the conjunctiva covering the outer surface of the eye (chemosis) and exposure after eye surgery. After eye removal surgery, tarsorrhaphy can also be used to hold devices, such as conformer shells, in place to maintain the shape of the eye socket.
Possible Risks of Tarsorrhaphy
Tarsorrhaphy is a surgical procedure that has few possible risks or long-term complications. Complications may include minor eyelid swelling and superficial infection. Occasionally, the surgery can cause short-lived decreases in peripheral vision, which resolve as the inflammation from surgery ceases. The risks of complications can also be significantly reduced by keeping the surgical site scrupulously clean and abstinence from the application of any makeup.
The expert physicians at the Facial Paralysis Institute have comprised a list of questions they are most frequently asked about tarsorrhaphy to help you in your quest to find the procedure that is right for you.
Q: What is a lateral tarsorrhaphy?
A. Lateral tarsorrhaphy is commonly used to protect the cornea and reduce excessive tearing and pain. With a lateral tarsorrhaphy, a surgeon attaches the lateral portion of the lower and upper lids together; this helps a patient partially close the eye.
During a lateral tarsorrhaphy, a surgeon makes an incision in the lateral of the upper and lower eyelid; the incision is made short of the lateral limbus of the iris. The surgeon next divides the anterior and posterior lamella, and a thin portion of the epithelium of the lid is excised. Finally, the posterior and anterior lamella of the upper and lower eyelids are sutured together.
Q. What is a temporary tarsorrhaphy?
A. Temporary tarsorrhaphy helps heal the cornea or protect the cornea during a short period of exposure or disease. Several types of temporary tarsorrhaphy are available, including:
Botox: Involves the use of the botulinum toxin to paralyze the upper lid levator muscle
Cyanoacrylate Glue: Involves the use of a weight in the upper lid to join the upper and lower lids
Drawstring: Involves the use of a drawstring that can be opened and closed to examine the eye
With tarsorrhaphy, a suture is typically used to join the upper and lower lids, regardless of whether the procedure is temporary or permanent.
Q: Who is a good candidate for tarsorrhaphy?
A: Because tarsorrhaphy typically compromises peripheral vision and can affect the aesthetics of the eye, it is not commonly indicated until alternatives, such as eye drops and contact lenses, have been attempted. Tarsorrhaphy may be beneficial for patients with temporary facial paralysis, such as Bell’spalsy, as the procedure can be reversed once normal function has returned. Dr. Azizzadeh and his team of oculoplastic surgeons can discuss all of your options with you during your consultation.
Q. How do I prepare for a tarsorrhaphy?
A. Tarsorrhaphy is typically performed as an outpatient surgery or in a doctor’s office, and most patients can return home the same day as treatment. A patient will be provided with instructions to help him or her prepare for tarsorrhaphy, but preparation is usually minimal.
A tarsorrhaphy patient should arrange for a responsible adult to drive him or her home after surgery. Tarsorrhaphy causes blurry vision immediately after surgery, and a patient should not attempt to drive home after treatment.
Q. What are the risks associated with tarsorrhaphy?
A. In some instances, patients experience vision changes and redness and swelling around the eye in the first few days after a tarsorrhaphy. Other potential tarsorrhaphy complications include minor eyelid swelling and surface irritation, but these complications are rare.
Q: What is the recovery like?
A: Tarsorrhaphy is an outpatient procedure with minimal risk. The recovery period is short and there is little pain involved. It is important to avoid touching or rubbing the eye, as well as wearing makeup, until advised by your doctor. It will also take time to adjust to the limited peripheral vision, which means activities like driving should be avoided until given approval.
Q: What other options do I have for restoring my eyelid function?
A: If tarsorrhaphy is not the best option for you, there are several other treatments available that have proven to be successful in treating incomplete eyelid closure. Gold or platinum weights can be implanted into the upper lid allowing it to use the force of gravity to close and protect the eye. Eyelid springs can also be implanted to restore dynamic function to the eyelid in a natural-looking manner. Call the expert team of doctors at the Facial Paralysis Institute today to schedule a consultation and find out which treatment is right for you.
Why Trust the Doctors at the Facial Paralysis Institute?
Our doctors at the Facial Paralysis Institute are among the most highly regarded specialists in their fields and bring a wealth of knowledge and experience to FPI. Board certified facial plastic surgeon Babak Azizzadeh, MD, FACS works with oculoplastic surgeon Guy Massry, MD to provide patients with the highest level of care and treat their incomplete eyelid closure caused by facial paralysis with a multidisciplinary approach.
Babak Azizzadeh, MD, FACS is a board-certified facial plastic surgeon, trained at Harvard, whose expertise in facial paralysis makes him one of the most highly regarded facial plastic surgeons in the country. In addition to being featured in various media outlets like Discovery Health, The New York Times, and the Oprah Winfrey Show, Dr. Azizzadeh is actively involved in research as well as teaching medical students at UCLA.
Guy Massry, MD is an oculoplastic surgeon specializing in cosmetic surgery of the eyelids. Known as “Dr. Fix-It,” Dr. Massry is a graduate of the USC School of Medicine and is highly regarded among his peers for his work and research in the field of oculoplastic surgery.
Contact the Expert Team at the Facial Paralysis Institute for a Consultation Today
If you would like more information on tarsorrhaphy or any of the other eyelid closure procedures, call us at (310) 657-2203 today to schedule a consultation with our team of facial paralysis and oculoplastic experts. The surgeons here at the Facial Paralysis Institute in Beverly Hills want you to be feeling and looking your best as soon as possible and are here to help.
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