Severing of tarsorrhaphy and steroid injection
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:19
Posted Feb 10, 2017
This is Richard Allen at the University of Iowa. This video demonstrates severing of a tarsorrhaphy as well as steroid injection in a patient who had a previous motor vehicle accident with extensive eyelid lacerations. The lacerations resulted in scarring and therefore the tarsorrhaphy was placed due to exposure keratopathy secondary to upper eyelid retraction. The tarsorrhaphy is demonstrated. Utility scissors are then used to incise along the junction of the upper and lower eyelid. I usually like to open the tarsorrhaphy partially rather than completely. This is especially true when a full tarsorrhaphy has been placed and I am unsure of how well the patient will close the eye. The shortening of the anterior lamella of the upper eyelid is demonstrate as well as the scar. The steroid is then injected in the area of the scar with a mixture of dexamethasone and triamcinolone. The concentration here is 10 milligrams per mL of dexamethasone and 40 milligrams per mL of triamcinolone. These are usually mixed together and injected. Is important to use a 27-gauge needle for this injection as a smaller bore needle will clog. The injection should be under the dermis. If the injection is too superficial, the white vehicle of triamcinolone can be visible for months. Another possible modality to use would be 5-FU for the injection. Postoperatively, the patient will be instructed to massage the areas in order to improve the scar. At the conclusion of the case, erythromycin ophthalmic ointment is placed into the eye. The patient will follow-up in approximately 1-2 weeks.
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