General Editor: Daniel Buchbinder

Authors: Damir Matic, John Yoo

Facial nerve - Irreversible paralysis, eye complex

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1 Introduction top


Goal of lateral tarsorrhaphy

The goal of lateral tarsorrhaphy is to protect the cornea and reduce symptoms of exposure, such as excessive tearing and pain.

Types of tarsorrhaphy

The procedure involves attaching the lateral portion of the lower and upper lids together to partially close the eye. It can be a temporary solution or a more definitive one.

The most commonly used tarsorrhaphy in paralyzed eyelids is permanent tarsorrhaphy, even if the patients are often unhappy due to both obstruction of lateral vision and cosmetic appearance.

For more information on temporary tarsorrhaphy please refer to the transcutaneous lower eyelid approaches in the midface section of the AO Surgery Reference.


This type of procedure can also be performed medially, to reduce medial ectropion.

2 Technique top

This procedure can be performed either under local or general anesthetic.



An incision is made in the lateral 1/4 to 1/3 of the upper and lower eyelid, stopping short of the lateral limbus of the iris.


Lamellae splitting

The anterior and posterior lamella is split along the grey line to a depth of 3-5 mm.

A thin portion of epithelium of the lid margin can be excised at this stage in order to reduce the risk of dehiscence.



The posterior lamella, followed by the anterior lamella, of the upper and lower eyelids are sutured together using a resorbable suture.


The posterior lamella sutures are inverted (buried) to prevent corneal irritation.


Care should be taken not to damage the eye lashes as this procedure is often reversed at the time of definitive eyelid surgery for eyelid closure.