Temporary tarsorrhaphy is a medical procedure involving the partial closure of the eyelids to protect the surface of the eye. This temporary measure is used when the eye cannot adequately protect itself due to issues with eyelid function or during a healing process. The procedure reduces the size of the opening between the eyelids, known as the palpebral fissure, which shields the front surface of the eye from damage. This intervention is used to preserve vision and promote healing when less invasive treatments, such as artificial tears or ointments, have been insufficient.
Defining Temporary Tarsorrhaphy
The goal of a temporary tarsorrhaphy is to create a moist, protective environment for the cornea, the clear, dome-shaped outer layer of the eye. Narrowing the eyelid opening minimizes the cornea’s exposure to air, dust, and injury. This reduced exposure helps curb tear evaporation, maintaining a healthy tear film.
The procedure is called temporary because it is intended to be fully reversible once the underlying medical condition resolves or the eye surface heals. This temporary approach contrasts with a permanent tarsorrhaphy, which involves surgically fusing the eyelid margins indefinitely to manage long-term or irreversible damage.
The protection prevents exposure keratopathy, which is damage and inflammation caused by prolonged dryness. The sealed environment supports the regeneration of the corneal epithelium, the outermost layer of the cornea. Since the eyelid anatomy is preserved, full eyelid movement is restored upon removal.
Conditions Requiring Eyelid Closure
The most frequent reason for temporary tarsorrhaphy is lagophthalmos, the inability to fully close the eyelids. This often results from damage to the facial nerve, such as in cases of Bell’s palsy, stroke, or trauma, which paralyzes the muscles responsible for eyelid closure. When the eyelids cannot meet, the exposed cornea dries out rapidly, risking severe damage.
The procedure is also used to protect the eye in patients with underlying conditions that cause the eye to protrude, such as proptosis seen in Graves’ disease. When the eyeball bulges forward, the eyelids cannot cover the surface completely, increasing the exposure risk. Protecting the cornea is also necessary following certain eye surgeries, like corneal transplants, or in the presence of non-healing corneal ulcers or abrasions.
These defects struggle to heal because constant friction and dryness impede the natural regenerative processes of the corneal surface. Patients who are critically ill or under prolonged sedation may require this intervention because their blink reflex is compromised or absent. In these situations, the temporary closure prevents severe exposure damage.
Techniques for Temporary Eyelid Closure
The method chosen depends on the anticipated duration of protection. For very short-term needs, simple lid taping uses surgical adhesive strips to temporarily pull the upper eyelid down. This quick, non-surgical solution can be easily undone for examination or cleaning.
For medium-term needs, traditional sutured tarsorrhaphy methods use intermarginal sutures that pass through the eyelid margins. Sutures may be reinforced with small bolsters on the skin surface to prevent cutting into the tissue. The drawstring technique is a variation that allows the physician to open and close the eyelid for examination without removing the entire closure.
A non-surgical method is chemodenervation via botulinum toxin injection. Injecting the toxin into the levator palpebrae superioris muscle, which lifts the upper eyelid, causes temporary paralysis. This results in a controlled, droopy eyelid (ptosis), effectively closing the eye for protection.
This chemical approach is preferred for longer-lasting, non-sutured closure, typically lasting three to six months. Other techniques include specialized adhesive appliqués applied to the upper eyelid to induce a temporary droop. Medical-grade cyanoacrylate glue has also been used to temporarily bond the eyelid margins for a few days.
Monitoring, Removal, and Recovery
The duration of a temporary tarsorrhaphy is dictated by the underlying reason for its application, generally lasting from a few weeks to several months. For example, a sutured closure may be planned for two to eight weeks, aligning with the expected healing time for a corneal defect. A botulinum toxin-induced closure will naturally wear off as muscle function slowly returns over several months.
Careful monitoring is necessary throughout the closure period to ensure the corneal surface remains healthy and that no complications, such as infection or suture erosion, develop. The physician will periodically check the eye to assess healing progress and comfort levels. The patient must also be vigilant for signs of inflammation or discharge.
Removal of the closure is straightforward. Sutures are snipped and removed in a clinical setting, adhesive tape is peeled away, and the effects of botulinum toxin gradually diminish. Once removed, the eye is often sensitive to light and air exposure, requiring continued use of lubricating eye drops or ointments as eyelid function returns to normal.