This is Richard Allen at the University of Iowa. This video demonstrates a permanent lateral tarsorrhaphy. Pre-operatively, the amount of the tarsorrhaphy has been determined and marked. An incision is then made with a 15 blade along the grey line between the anterior and posterior lamella of the lower eyelid. This incision can be made with the surgeon’s blade of choice. Westcott scissors are then used to dissect between the anterior and posterior lamella to appropriately free the anterior lamella from the posterior lamella. The mucocutaneous junction of the posterior lamella is then excised with Westcott scissors. In general, I avoid cautery during tarsorrhaphies as the blood is probably helpful for the eye, the bleeding stops, and hemostasis may result in subsequent dehiscence. Attention is then directed to the upper eyelid where the incision is made along the eyelid margin between the anterior and posterior lamella. Westcott scissors are then used to complete the dissection. The mucocutaneous junction is then excised from the posterior lamella along the length of the proposed tarsorrhaphy. The posterior lamella of the lower eyelid is then sutured to the posterior lamella of the upper eyelid with interrupted 5-0 vicryl sutures. It is important not to make these suture passes full thickness, as this would cause irritation post-operatively. Depending on the length of the tarsorrhaphy, a variable number of sutures will be required. In this case, three to four sutures are needed to complete closure of the posterior lamella. The anterior lamella is then sutured together with interrupted 7-0 vicryl sutures. At the conclusion of the case, antibiotic ointment is placed over the tarsorrhaphy.