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

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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. The anterior lamella of the lower lid is then sutured to the anterior lamella of the upper lid using absorbable or permanent 5-0 to 6-0 suture in an interrupted fashion. [1] [13]

Allen, R. “Pillar tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library. Two bolsters of the surgeon's choice of size and material (plastic tubing, red robin catheter, cotton wool balls, etc.) are prepared. If it is anticipated that the suture will be removed within 2 weeks and there is no skin compromise, bolsters may not be necessary. After washing and preparing the eye thoroughly within the lid margins and fornices, the glue gel of choice is applied along closed lateral eyelid margins using the standard applicator tip supplied with the gel. Using the same applicator tip, the gel is spread medially along the eyelid margins to achieve the desired amount of closure. The glue is allowed to dry for 15 – 20 seconds. Once dry, the eyelids stay closed for approximately 2 weeks. [5] [16] Some report longer lasting closure with a recent study in a pediatric population reporting that cyanoacrylate glue tarsorrhaphies last an average of 4.5 weeks (range 0.5-13 weeks). [17] It can be reversed by cutting the eyelashes following the application of lidocaine gel. If the eye needs to be opened the smaller bolster is separated from the larger lower eyelid bolster, which allows the eyelid to be examined or to receive treatment

Scissor - Stevens Tenotomy, Curved, Length 11cm

Illustration of a Pillar tarsorrhaphy step-by-step approach. Image c reated by by Fabliha A. Mukit, MD using an iPad and the Procreate app. Technique Hogeweg M, Keunen JE. Prevention of blindness in leprosy and the role of the Vision 2020 Programme. Eye. 2005: 19, 1099–1105. The needle is then turned around and passed 3-4 mm below the lower lid skin, through the lid margin and retrieved from the meibomian gland orifices.

Inadequate blinking secondary to reduced corneal sensation, Riley Day Syndrome/Familial Dysautonomia, severe brain injury, or prolonged sedation [1] 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. The needle is then passed through the upper lid skin 3-4 mm above the lid margin, exiting through the meibomian gland orifices. The 4-0 silk everting sutures are removed, and the eyelids are inspected to ensure appropriate closure. [3] [14]Lee V, Currie Z, Collin JRO. Ophthalmic Management of Facial Nerve Palsy. Eye. 2004; 18: 1225-1234. 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. silk sutures are passed through the upper eyelid at the level of the meibomian gland orifices and the eyelid is everted over a speculum. Proptotic exposure secondary to thyroid eye disease or other inflammatory orbital disease, and orbital tumors [1]

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. “Temporary bolster 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. A medial tarsorrhaphy is another useful technique when applicable. This technique is modified to avoid damage to the canaliculi and involves making a V-shaped incision peripheral to the canaliculi to the upper and lower lids. The medial tarsorrhaphy is advantageous in that it does not interfere with peripheral vision.A #15 Bard-Parker blade is used to cut through the skin and orbicularis adjacent to the canaliculus.

Our Westcott Tenotomy Scissor comes with rounded tips that are ideal for blunt dissection of tissues. 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 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. In summary: The suture is passed through the bolster, followed by the upper eyelid, then the lower eyelid, then the second bolster. Once the second bolster is engaged, the suture is turned around and placed through the second bolster, then the lower eyelid, then the upper eyelid, and the bolster. The suture is then tied to complete the tarsorrhaphy. [12] 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.An absorbable or nonabsorbable double armed 4-0 to 6-0 suture is initially passed through the bolster material. To retain a prosthesis, Boston Keratoprosthesis, or other device in patients with anophthalmia or after evisceration or enucleation A #15 blade is used to make 2 parallel incisions that are connected at one end to develop two pillars of tarsoconjunctiva tissue, one corresponding to the medial limbus and one corresponding to the lateral limbus.