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

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

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.

Scissor - Stevens Tenotomy, Curved, Length 11cm

Inadequate blinking secondary to reduced corneal sensation, Riley Day Syndrome/Familial Dysautonomia, severe brain injury, or prolonged sedation [1]

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. In addition, the operating scissor includes fine serrations to improve grip. It also has small blades to shank ratio for better control. 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 The temporary suture tarsorrhaphy can be placed anywhere along the lid margins. If inspection of the cornea at intervals is desired, a drawstring tarsorrhaphy technique can be utilized. Allen, R. “Temporary bolster tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library.Allen, R. “Glue tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library. Lagophthalmos due to facial nerve palsies (neurogenic exposure keratopathy), cicatricial damage to the eyelids, anorexia nervosa, leprosy, Ramsay Hunt Syndrome Type 2, orbital tumors, and thyroid eye disease [1] [7] [8] [9] An absorbable or nonabsorbable double armed 4-0 to 6-0 suture is initially passed through the bolster material. Made in premium quality stainless steel with satin finish to reduce glare. The instrument can be sterilized and reused. Specialty 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]

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. The 4-0 silk everting sutures are removed, and the eyelids are inspected to ensure appropriate closure. [3] [14]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] Three bolsters of the surgeon's choice of size and material (plastic tubing, red robin catheter, cotton wool balls, etc.) are prepared. 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] Donnenfeld ED, Perry HD, Nelson DB. Cyanoacrylate temporary tarsorrhaphy in the management of corneal epithelial defects. Ophthalmic Surg. 1991;22591- 593. The posterior lamellae of the upper and lower lids are sutured together using 5-0 or 6-0 Vicryl suture in interrupted fashion.