Lower eyelid tarsotomy
This is Richard Allen at the University of Iowa. This video demonstrates the use of a tarsotomy with everting sutures for repair of cicatricial entropion. In this case, the patient is also to have a lateral tarsal strip, thus a lateral canthotomy and inferior cantholysis is performed. A 4-0 silk traction suture has been placed and the eyelid is everted over a shoe horn speculum. A 15 blade is then used to make an incision through the tarsus approximately 2-3 mm inferior to the superior border of the tarsus. The incision extends for the length of the area of the entropion. Westcott scissors are then used to complete the incision through the tarsus to the level of the pretarsal orbicularis muscle. The traction suture is then removed. A double armed 5-0 vicryl suture on an S-24 needle is then placed through the inferior cut end of the tarsus. Each arm of the suture is then placed full thickness through the eyelid to exit at the level of the lash follicles. The suture is tied. The suture is now a single armed suture as we are using the same suture. The needle enters at the lash follicles and passed through the eyelid to exit at the tarsal incision. The needle then engages the cut end of the tarsus and is then turned around and placed full thickness through the eyelid to exit at the lash follicles. The suture is then again tied. Approximately 3-6 sutures can be placed in order to evert the lid margin. In this case the patient will have a lateral tarsal strip as well to stabilize the eyelid horizontally.