Exophthalmos

Definition

Tarsorrhaphy is a rare procedure where the eyelids are partially sewn together to narrow the opening.

Purpose

The eye needs the lids to protect it. It also needs tears and periodic blinking to cleanse it and keep it moist. There are many conditions that impair these functions and threaten the eye, specifically the cornea, with drying. Until they can be corrected, sewing the eyelids partially together helps protect the eye.

A partial list of the conditions that can require tarsorrhaphy includes:

• Paralysis or weakness of the eyelids so that they cannot close or blink adequately. Bell's palsy is a nerve condition that weakens the muscles of the face, including the eyelids. It is usually temporary. Myasthenia gravis also weakens facial muscles, but it is usually treatable. A stroke can also weaken eyelids so they do not close.
• Exophthalmos (the eyes sticking out of their sockets) occurs with Graves' disease of the thyroid and with tumors behind the eyes. If the eyes stick out too far, the lids cannot close over them.
• Enophthalmos is when the eye falls back into the socket so that the eyelid function is inadequate.
• Several eye and corneal diseases cause swelling of the cornea and require temporary added protection until the condition resolves.
• Sjögren's syndrome reduces tear flow to the point where it can endanger the cornea.
• Dendritic ulcers of the cornea caused by viruses may need to be covered with the eyelid while they heal.

Precautions

The use of eye drops and contact lenses to moisten and protect the eyes must be considered first before tarsorrhaphy is performed.

Description

Stitches are carefully placed at the corners of the eyelid opening (called the palpebral fissure) to narrow it. This allows the eye better lubrication and less exposure to the air. Eyeball motion can then help bathe the cornea in tears when it rolls up under the lid. The outpatient procedure is done under local anesthetic.

Preparation

Tarsorrhaphy is a minor procedure done under local anesthesia. Special preparation is not necessary.

Aftercare

Eye drops or ointment may still be needed to preserve the cornea or treat accompanying disease.

Risks

Tarsorrhaphy carries few risks. If complications occur, they are usually minor eyelid swelling and superficial infection.

Key Terms

Cornea

The clear part of the front of the eye through which vision occurs.

Enophthalmos

A condition where the eye falls back into the socket and inhibits proper eyelid function.

Exophthalmos

A condition where the eyes stick out of their sockets and inhibit proper eyelid function.

Palpebral fissure

Eyelid opening.

Sjögren's syndrome

A connective tissue disease that hinders the production of tears and other body fluids.

Further Reading

For Your Information

Books

• Sardegna, Jill Otis and T. Paul. The Encyclopedia of Blindness and Vision Impairment. New York: Facts on File Inc., 1990, p.212.

Gale Encyclopedia of Medicine. Gale Research, 1999.