Tarsorrhaphy refers to a surgical procedure where the lower and upper eyelids are wholly or partially sewn together. The eye needs protection from the many conditions that threaten eyelid function. It also needs tears and periodic blinking to keep the cornea from drying. 

Partial tarsorrhaphy is performed to help the cornea heal or protect it from exposure caused by conditions with inadequate eyelid coverage such as Bell palsy and Graves’ disease. Patients with tear film deficiency, stem cell dysfunction, neurotrophic lesions, and herpes simplex can also benefit from tarsorrhaphy surgery. 

Permanent tarsorrhaphy (lateral tarsorrhaphy) helps protect the cornea from the risk of damage, long term. 

In lateral tarsorrhaphy, the outer (lateral) eyelids are closed to enable the patient to see through the central opening. Corneal lesions that are difficult to heal can benefit from lateral tarsorrhaphy. 

Tarsorrhaphy is also performed in patients with severe brain injury or those in the intensive care unit and have inadequate or infrequent blinking. It can also promote the cornea's healing in non-healing abrasions and infected corneal ulcers with delayed healing. The procedure is used to prevent conjunctival chemosis (swelling) and exposure after ocular surgery. It can also be performed following enucleation or evisceration to retain a conformer. 

Other conditions where the procedure may be used include Sjögren's syndrome to reduce tear flow, virus-causing dendritic ulcers, and enophthalmos (the eye falls back into the socket rendering the eyelid ineffective).

Preparation & Expectation Before Surgery

There are no special preparations required and the patient can go back home on the same day, as it is performed in an outpatient setting. The patient should organize a responsible adult to drive them home after the procedure because of blurred vision and reduced peripheral vision. The procedure should last about 30 minutes.

Types, Purpose & Procedure

Tarsorrhaphy is a safe procedure that protects the eye and returns moisture to dry eyes. It is mainly done in two different procedures, temporary (short-term) and permanent (long-term).

The patient has their eye measurements taken, before local anesthesia is administered to numb the area around the eye. Eye drops and contact lenses may be used to moisten and protect the eyes before the procedure. The outpatient procedure is done under local anesthetic (lidocaine or bupivacaine). If anesthesia with adrenaline is available, it’s preferred because it reduces postoperative bleeding.

1. The drawstring temporary central tarsorrhaphy

It is a temporary central tarsorrhaphy procedure, that allows the eyelids repeated opening and closure whenever the eye needs examination. This type of tarsorrhaphy is effective for 2-8 weeks.

The surgeon:

  • Cleans the area with an iodine solution and leaves it for a few minutes
  • Sutures the eyelids at the palpebral fissure (corner of eyelid opening) using a double-armed non-absorbable suture or single-armed suture

2. The permanent tarsorrhaphy

A permanent tarsorrhaphy is always lateral to allow the patient to see out of the central eyelid opening. It also gives room for the eye to be examined. The estimated duration time for the procedure’s effects to last should be three months or forever.

The surgeon:

  • Cleans the area with an iodine solution and leaves it for a few minutes
  • Using a blade, splits the anterior and posterior lamellae and cuts along the lateral third of the lower and upper eyelids. The split is kept parallel to the tarsal plate, and the eyelid may bleed. The surgeon can control the bleeding  by applying minimum pressure. S/he can also use cautery (electrical treatment) to stop the bleeding, if necessary.
  • Excises the posterior lamella (1 mm) to remove the lid margin’s epithelium which will enable the sticking together of the lids when they heal
  • Uses an absorbable suture (5-0 to 6-0) to close the posterior lamella
  • Closes the anterior lamella using a 4-0 to 6-0 suture 


Risks, Side Effects & Complications

There are very few risks associated with tarsorrhaphy. The operated area will likely swell and become red. Complications are rare and may include:

  • Surface infection
  • Minor eyelid inflammation
  • Undesirable vision changes
  • Worsening redness around the eye
  • Increased, persistent pain despite medications


After Care, Recovery & Outcome

The patient can apply a cold compress for the relief of any discomfort. Pain should go away on its own in a few days, although analgesics can be used. However, abnormal pain should be addressed by a physician as soon as possible. Sutures are removed in 14 days.

The patient still needs to use eye drops or ointments to treat accompanying conditions or preserve the cornea. The area may also be sensitive, and the patient should avoid rubbing the eyes.

Peripheral vision will be affected so the patient should take time to adjust. To make up for the affected peripheral vision, the patient can turn the head to look at objects. Activities like driving should also be avoided for some time. Makeup is strongly discouraged until the doctor gives the go-ahead.