38 EyeWorld Asia-Pacific | June 2025 Dr. Kim said since corneal fellowship, he has performed hundreds of surgical suture tarsorrhaphies (both temporary and permanent), but a few years ago, a representative from Bio-Tissue showed him a technique using a rigid piece of tape. “I have since given it the name tape tarsorrhaphy, then Dr. Michael Mimouni and the University of Toronto Cornea Department modified it to a more accurate description, which we now call tapesplint tarsorrhaphy.1 The tape-splint tarsorrhaphy has superseded my use of surgical temporary tarsorrhaphy, and it has been an invaluable tool because it is nonsurgical, easily reversible, and the patient can apply it themselves,” he said. Dr. Kim noted that tape tarsorrhaphy doesn’t work for all situations. “If there is a deep set orbit or excessively oily skin, it may not effectively splint the eyelid. There can also be intolerance due to contact dermatitis from the tape adhesive. Other times, a more permanent and aggressive method needs to be considered for chronic corneal exposure with a surgical suture tarsorrhaphy or a Gunderson flap, but I think from a patient informed consent perspective, the tape-splint tarsorrhaphy should be offered early in the process as a safe, non-surgical option.” Dr. Kim added that when performing a temporary suture tarsorrhaphy, he always uses bolsters to protect the lid. He also suggested using a slip knot to titrate tension. For permanent lateral tarsorrhaphy, Dr. Kim said his best pearl is when removing the anterior lamella of the eyelid margin, spare the lateral canthal area about 3–4 mm. “This is important because if and when you try and reverse the tarsorrhaphy, you will avoid rounding of the lateral canthus and achieve a much better cosmetic result,” he said. Dr. Houser said she doesn’t use bolsters. “It’s a great procedure, with or without bolsters,” she said. Dr. Dermarkarian, as an oculoplastics specialist, said permanent tarsorrhaphies are not a significant component of his practice, but he performs up to two a week. “I think anytime that people are asking for permanent tarsorrhaphy or a variation of the standard tarsorrhaphy, that is when they end up in my clinic for evaluation,” he said. Dr. Dermarkarian discussed several “artistic variations” on the classic temporary suture tarsorrhaphy. He said glue tarsorrhaphies typically last for 5–7 days, and Botox tarsorrhaphies can cause complete ptosis that can last up to around 3 months. He said he doesn’t like the latter methodology because it is not as predictable, there could be hematoma formation in the eyelid or muscle, and there isn’t good control of the tarsorrhaphy timeline. For permanent tarsorrhaphies, Dr. Dermarkarian places an incision through the gray line of the upper and lower eyelid margins and sutures the back part of the upper and lower eyelid together, then sutures the front part of the upper and lower eyelids together. “In simple terms, the eyelid and eyelid margin are made up of two parts. There’s the skin and the muscle on the front side, and there’s the tarsus on the back side. The tarsus is like a form of cartilage. When you perform a permanent tarsorrhaphy, you want the upper eyelid tarsus to adhere to the lower eyelid tarsus, and you want to do the same for the skin and muscle of the upper and lower eyelid,” Dr. Dermarkarian said. “So medially you could do that, laterally you could do it, or you could do the entire eyelid depending on how much the eye needs to be closed.” Dr. Dermarkarian said he thinks it’s important for patients to hear that even “permanent” tarsorrhaphies are reversible. “I always discuss with patients that it’s a great technique for healing, but if they hate it or if they’re miserable, we can easily take it apart in the clinic setting.” CORNEA About the Physicians Christopher R. Dermarkarian, MD | Assistant Professor of Ophthalmology, Oculofacial and Orbital Surgery, Duke University School of Medicine, Durham, North Carolina | christopher.dermarkarian@duke.edu Kourtney Houser, MD | Associate Professor of Ophthalmology, Duke University School of Medicine, Durham, North Carolina | kourtney.houser@duke.edu D. Brian Kim, MD | Professional Eye Associates, Dalton, Georgia | docdbk100@gmail.com Christopher Rapuano, MD | Chief of the Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania | cjrapuano@willseye.org Relevant Disclosures Dermarkarian: None Houser: None Kim: None Rapuano: None Reference 1. Mimouni M, et al. Tape splint tarsorrhaphy for persistent corneal epithelial defects. Am J Ophthalmol. 2022;237:235–240. This article originally appeared in the March 2025 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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