1. A Bloodless method of Tarsorrhaphy
Leela V. Raju MD
University of Pittsburgh, Pittsburgh, PA
Madhavi Ghanta DNB
Goutami Eye Institute, AP, India
V.K. Raju MD, FRCS
Monongalia Eye Clinic, Morgantown, WV
The authors have no financial interests to disclose.

2. Background
Tarsorrhaphy is an important fundamental ophthalmic technique and is indicated in a variety of conditions to aid the healing process of the cornea.

3. Purpose
To describe a simple, bloodless method of tarsorrhaphy that can be perfomed safely and efficiently in any setting, e.g. a nursing home. This procedure takes less time than other methods of permanent tarsorrhaphy and does not require suture removal.

4. Low temperature cautery
Methods
Low temperature cautery
5-0 or 6-0 vicryl suture
11-blade

5. Methods
Under local anesthesia, low temperature cautery is used to remove epithelium on the lower and upper lid margins.

6. Methods
An 11 blade is used to split the lid at the gray line into the tarso-conjunctiva and tarso-muscle of the upper and lower lids.
Any minimal bleeding can be absorbed with a Q-tip at this time.

7. Methods
A 5-0 (or 6-0) double armed vicryl suture is then passed (4-5mm apart) through the skin just below the ciliary margin, through the split margins of the lower and upper lids, and back out through the upper lid skin.

8. Methods
This can also be done with a single armed suture. Before the suture is tied, a small scratch is made on the skin to bury the knot.

9. Methods Antibiotic ointment is applied.
Usually a patch is not necessary as there is hardly any bleeding.

10. Results In 75 cases, we have only experienced 2 broken sutures
This method of tarsorrhaphy can be done in all settings, especially in a nursing home where follow up may be difficult
In our experience, this can be performed in a bloodless fashion and reduce the amount of postoperative medication- especially in dry eye patients

11. Conclusion
This method of tarsorraphy can be done efficiently in any setting. Use of vicryl suture precludes the need for suture removal.

13. References
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