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

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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. Made in premium quality stainless steel with satin finish to reduce glare. The instrument can be sterilized and reused. Specialty Use of any tissue glue or cyanoacrylate glue gel can be a simple, alternative method for creating a temporary tarsorrhaphy unstable for invasive procedures, for temporary eyelid apposition for persistent epithelial defects, or for ease of use in any setting. [5] [15] Technique

Allen, R. “Glue tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library. 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.

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. Illustration of a Temporary Bolster Tarsorrhaphy step-by-step approach. Image drawn by Fabliha A. Mukit using an iPad and the Procreate app. Temporary Bolster Tarsorrhaphy Technique Tarsorrhaphy is a safe and relatively simple procedure in which part, or all the upper and lower eyelids are joined together to cover the eye partially or completely. Tarsorrhaphies are highly effective in the management of nonhealing epithelial defects and other corneal surface pathology by creating a more hospitable environment for corneal healing. [1] Tarsorrhaphies can be permanent or temporary, total or partial, and can be further classified into short duration tarsorrhaphies without sutures, temporary suture tarsorrhaphies, permanent suture tarsorrhaphies, and more extensive tarsorrhaphies that involve mobilization of skin or tarsal plate flaps. [2] To retain a prosthesis, Boston Keratoprosthesis, or other device in patients with anophthalmia or after evisceration or enucleation

The suture is then tied over the bolster to complete the tarsorrhaphy. The suture should be snug to prevent incomplete lid opposition when intraoperative edema resolves. Fu L, Patel BC. Lagophthalmos. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 10, 2020. Lee V, Currie Z, Collin JRO. Ophthalmic Management of Facial Nerve Palsy. Eye. 2004; 18: 1225-1234. A #15 Bard-Parker blade is used to cut through the skin and orbicularis adjacent to the canaliculus.Hogeweg M, Keunen JE. Prevention of blindness in leprosy and the role of the Vision 2020 Programme. Eye. 2005: 19, 1099–1105.

In addition, the operating scissor includes fine serrations to improve grip. It also has small blades to shank ratio for better control. Trivedi D, McCalla M, Squires Z, Parulekar M. Use of cyanoacrylate glue for temporary tarsorrhaphy in children. Ophthalmic Plast Reconstr Surg. 2014 Jan-Feb;30(1):60-3. doi: 10.1097/IOP.0000000000000011. PMID: 24398490. 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 Kasaee A, Musavi MR, Tabatabaie SZ, et al. Evaluation of efficacy and safety of botulinum toxin type A injection in patients requiring temporary tarsorrhaphy to improve corneal epithelial defects. Int J Ophthalmol. 2010;3(3):237-240. doi:10.3980/j.issn.2222-3959.2010.03.13. Khairy H. Botulinum toxin A-induced ptosis: A safe and effective alternative to surgical tarsorrhaphy for corneal protection. Journal of the Egyptian Ophthalmological Society. 2014;107(1):20-22. doi:10.4103/2090-0686.134937.The needle is then passed through the meibomian gland orifices of the upper lid margin and retrieved 3-4 mm above the upper lid margin and engages the upper bolster. The upper eyelid is prepped with Betadine solution and the desired concentration is drawn up into a 1 mL insulin or tuberculin syringe. Introduce the needle tip of a 23 to 26-gauge needle just below the superior orbital rim along the mid-pupillary plane and passed against the orbital roof for 1 to 2 cm. The desired amount of botulinum toxin is injected, and the needle and syringe are discarded appropriately. The patient should then be monitored closely for appropriate healing and resolution of ptosis with return of levator function. [18] [19] Repeat injection may be necessary. Inadequate blinking secondary to reduced corneal sensation, Riley Day Syndrome/Familial Dysautonomia, severe brain injury, or prolonged sedation [1] 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

Donnenfeld ED, Perry HD, Nelson DB. Cyanoacrylate temporary tarsorrhaphy in the management of corneal epithelial defects. Ophthalmic Surg. 1991;22591- 593. An absorbable or nonabsorbable double armed 4-0 to 6-0 suture is initially passed through the bolster material. The needle is then passed through the upper lid skin 3-4 mm above the lid margin, exiting through the meibomian gland orifices. Our Westcott Tenotomy Scissor comes with rounded tips that are ideal for blunt dissection of tissues.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.