Page 183 - Manual of Equine Field Surgery

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CHAPTER 33

Temporary Tarsorrhaphy

Laurence E. Galle

eyelids are composed of skin, muscle, a fibrous

INDICATIONS tarsal plate, and conjunctiva from the external to

internal surfaces. The rneibomian glands are

A temporary tarsorrhaphy is performed to pro- buried within the distal end of the fibrous con-

vide temporary decreased exposure of the globe, nective tissue tarsal plate with openings in the

protection of the cornea, or both."? It is most eyelid margin. Well-developed cilia (eyelashes) are

often used to protect a11 ulcerated cornea but may on the t1pper eyelid" (see Figure 28-2).

also be used to maximize eyelid closure when

excessive corneal exposure is likely ( e.g., facial

nerve [CNVII] paralysis-paresisj.l" PROCEDURE

The skin of the dorsal eyelid is grasped with

EQUIPMENT forceps, and a simple horizontal mattress suture

of No. 2-0 or No. 3-0 monofilament nylon is

Derf needle drivers, Bishop-Harmon ophthalmic placed using a curved cutting needle. The suture

forceps, and general operating scissors are neces- pattern is started 5 mm from the dorsal eyelid

sary for this procedure. margin, and the needle should be inserted down

to, but not through, the fibrous tarsal plate. The

needle should be advanced such that it exits the

PREPARATION AND POSITIONING eyelid margin slightly anterior to the meibomian

gland orifices. The horizontal mattress suture

This procedure is most easily performed using crosses the palpebral fissure, is inserted into the

general anesthesia with the patient in lateral ventral eyelid margin slightly anterior to the 111ei-

recumbency, It can be performed, however, in a bomian gland orifices, and should exit the eyelid

standing patient with heavy sedation and appro- skin approximately 5 mm from the eyelid. This

priate nerve blocks to obtain eyelid akinesia and completes half of the mattress suture. The hori-

sensory anesthesia. zontal mattress suture is completed by placing the

suture from the ventral to dorsal eyelid using the

same depth of suture placement as in the first half

ANATOMY of the suture placement. The number and spacing

of the horizontal mattress sutures are determined

A thorough understanding of eyelid anatomy is by the surgeon.7'8 Stents may be used to minimize

imperative for appropriate suture placement in a cutting of the suture into the eyelid.8 The eyelids

temporary tarsorrhaphy. The major layers of the may be completely closed with this technique, or

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