Retractor recession with medical and lateral tarsorrhaphy
Richard C. Allen, MD, PhD
Additional Notes: Length 03:43
Posted March 20, 2017
This is Richard Allen at the University of Iowa. This video demonstrates a lower eyelid retractor recession with medial and lateral tarsorrhaphy in a patient with exposure keratopathy. A 4-0 silk suture is placed through the lower eyelid at the level of the tarsus in order to provide traction during the case. A thermal cautery is then used to make an incision inferior to the inferior border of the tarsus. Dissection is then carried out between the orbital septum and the orbicularis muscle to the inferior orbital rim. Dissection is then carried out between the conjunctiva and the surface of the lower lid retractors. This is performed to the level of the fornix. The retractors are allowed to recess. The conjunctival incision is then closed with interrupted 7–0 Vicryl sutures. The recession of the eyelid is demonstrated with elevation of the lower eyelid. A lateral tarsorrhaphy will then be performed. A 15 blade is used to make an incision along the gray line. Westcott scissors are then used to dissect the pretarsal orbicularis from the anterior surface of the tarsus. The mucocutaneous junction is then excised from the posterior lamella. The same is then performed for the upper lid with an incision along the gray line followed by dissection between the orbicularis muscle and the underlying anterior surface of the tarsus. The mucocutaneous junction is excised from the posterior lamella. The posterior lamella of the lower lid will then be sutured to the posterior lamella of the upper lid with a 5–0 Vicryl suture which is placed partial thickness through the anterior surface of the tarsus. Approximately 2-3 sutures are placed. The anterior lamella is then sutured together with interrupted 7–0 Vicryl sutures. This completes the lateral tarsorrhaphy. Attention is then directed medially where medial tarsorrhaphy will be performed. A 15 blade is used to make a V-shaped incision extending from the level of the punctum laterally to the medial canthus medially along both the upper and the lower lid. The orbicularis muscle is then sutured together with the 5–0 Vicryl suture. Two sutures are usually needed for medial tarsorrhaphy. The skin can then be closed with the 7–0 Vicryl suture in an interrupted fashion. At the conclusion of the case, Erythromycin ophthalmic ointment is placed over the area. The patient will return in approximately 1 week for reevaluation.
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