This is Richard Allen at the University of Iowa. This video demonstrates a pillar tarsorrhaphy. 4-0 silk sutures are placed through the upper eyelid at the level of the meibomian gland orifices. The eyelid is then everted over a shoe horn speculum. A 15 blade is then used to make incisions to develop two tongues or pillars of tissue, one corresponding to the medial limbus and one corresponding to the lateral limbus. The pillars are then elevated with Westcott scissors and dissection is carried out above the superior border of the tarsus of the upper eyelid. This is completed with a thermal cautery. The same dissection is performed on each tongue or pillar or tissue. Attention is then directed to the lower eyelid where a rectangle of tarsus is excised at the eyelid margin with the 15 blade and Westcott scissors. This is at the level of each of the pillars. The pillar is then engaged with a double arm 5-0 vicryl suture. This 5-0 vicryl suture is then placed through the lower eyelid through the area of the excised rectangle of tissue. This transposes the pillar to the raw surface of the lower eyelid. The same is performed for the lateral pillar. The sutures are then tied over cotton bolsters to complete the tarsorrhaphy. The 4-0 silk sutures are then removed. Inspection of the eyelids shows them to be appropriately closed. The patient follows up in approximately one week for removal of the bolsters.