Upper eyelid tarsotomy
This is Richard Allen at the University of Iowa. This video demonstrates an upper eyelid tarsotomy with everting sutures for cicatricial entropion. A 4-0 silk traction suture is placed and the eyelid is everted over a shoe horn speculum. A 15 blade is then used to make an incision 2-3 mm from the eyelid margin full thickness through the tarsus along the extent of the area of entropion. Westcott scissors are then used to complete the full thickness tarsal incision to the level of the pretarsal orbicularis muscle. The pretarsal orbicularis muscle is visualized as demonstrated here. This freely mobilizes the eyelid margin for eyelid eversion. The traction suture is then removed. A 5-0 Vicryl suture on an S-24 needle is then placed entering at the level of the lash follicles and exiting at the tarsal incision. The cut edge of the tarsus is then engaged with the suture and the suture is turned around to exit at the level of the eyelash follicles. This suture is left untied so that an adjacent suture can be placed easily. Again, the suture is placed through the eyelid at the level of the eyelash follicles. The suture then engages the cut edge of the tarsus, then the suture is turned around to exit at the level of the eyelash follicles. To demonstrate this one last time, the suture enters at the eyelash follicles, engages the cut edge of the tarsus, followed by exiting at the lash follicles. The sutures are then tied and tying the suture should result in eversion of the eyelid margin. I have yet to over correct a patient with this procedure. Approximately 3-6 sutures are placed. At the end of the case the eyelid margin should be everted. Antibiotic ointment is then placed into the eye and the sutures are removed at 7-10 days.