Technique and Results of Permanent Medial Tarsorrhaphy for Complex Eyelid Malposition

Purpose: To evaluate the results of permanent medial tarsorrhaphy and to describe the surgical technique. Methods: Medial tarsorrhaphy was performed on 30 eyelids with symptomatic exposure keratopathy secondary to eyelid malposition. Observational, retrospective review of preoperative and postoperative examination findings was performed. Results: Average age of the cohort was 66 years (31–91). Medial tarsorrhaphy was performed to correct eyelid retraction (100%), exposure keratopathy (80%), lagophthalmos (57%), and ectropion (17%) in patients with cranial nerve VII palsy (47%), Graves eye disease (13%), eczema (7%), floppy eyelid syndrome (7%), after Mohs reconstruction (7%), orbital myositis (3%), and neurofibromatosis (3%). Seventy-three percent (73%) of patients had an average of 3 surgeries (N = 22, standard deviation = 1.12, range = 2–7) before undergoing medial tarsorrhaphy. Medial tarsorrhaphy was performed in combination with another procedure in 53% of cases. Palpebral fissure decreased postoperatively an average of 1.1 mm (N = 20; p = 0.005), inferior scleral show decreased 0.72 mm (N = 22; p = 0.03), lagophthalmos decreased 0.4 mm (N = 15; p = 0.27), and superficial punctate keratopathy improved by 61% (N = 27; p = 0.009). Ectropion completely resolved in 4 of 10 patients (40%). Seven patients (23%) required additional surgery following tarsorrhaphy an average of 8 months later (range = 2–16). In 1 patient (3%), a tarsorrhaphy opened prematurely, and 1 patient (3%) requested partial opening of the tarsorrhaphy. Average duration of follow up was 13 months (N = 30, standard deviation = 14.97, range = 0.2–45.7). Conclusions: Medial tarsorrhaphy is a safe and effective primary or salvage technique to address complex causes of eyelid retraction, lagophthalmos, ectropion, and exposure keratopathy. Accepted for publication October 9, 2018. The authors have no financial or conflicts of interest to disclose. A portion of this study was presented at the following meeting: American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) (Poster) on November 10, 2017 in New Orleans, LA. Address correspondence and reprint requests to Kira L. Segal, M.D., Department of Ophthalmology, Weill Cornell Medical College/New York-Presbyterian Hospital, 1305 York Avenue, 11th and 12th Floors, New York, NY, 10021, U.S.A. Email: kls2003@med.cornell.edu. © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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