Westcott E-30440 00 Titanium Super Soft Grip Scissor, 10 cm- Grey/Yellow

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Inadequate blinking secondary to reduced corneal sensation, Riley Day Syndrome/Familial Dysautonomia, severe brain injury, or prolonged sedation [1] The upper eyelid is prepped with Betadine solution and the desired concentration is drawn up into a 1 mL insulin or tuberculin syringe. Introduce the needle tip of a 23 to 26-gauge needle just below the superior orbital rim along the mid-pupillary plane and passed against the orbital roof for 1 to 2 cm. The desired amount of botulinum toxin is injected, and the needle and syringe are discarded appropriately. The patient should then be monitored closely for appropriate healing and resolution of ptosis with return of levator function. [18] [19] Repeat injection may be necessary.

Especially includes narrow blades which increase precision. Moreover, the instrument has curved blades that contort to the surface of the eye for increased accuracy. Ehrenhaus M, D'Arienzo P. Improved Technique for Temporary Tarsorrhaphy With a New Cyanoacrylate Gel. Arch Ophthalmol. 2003;121(9):1336–1337. doi:10.1001/archopht.121.9.1336. The final step is to create the drawstring, the 2 suture arms are passed through the 3rd bolster (it is commonplace to make this smaller than the other ones) Illustration of a Temporary Bolster Tarsorrhaphy step-by-step approach. Image drawn by Fabliha A. Mukit using an iPad and the Procreate app. Temporary Bolster Tarsorrhaphy TechniqueA #15 blade is used to make 2 parallel incisions that are connected at one end to develop two pillars of tarsoconjunctiva tissue, one corresponding to the medial limbus and one corresponding to the lateral limbus. Allen, R. “Glue tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library.

The temporary suture tarsorrhaphy can be placed anywhere along the lid margins. If inspection of the cornea at intervals is desired, a drawstring tarsorrhaphy technique can be utilized. A #15 Bard-Parker blade is used to cut through the skin and orbicularis adjacent to the canaliculus.Prior to the procedure, a full ophthalmic examination should be performed and documented. A thorough slit lamp biomicroscopic examination should document corneal pathology and the size and location of any defects or corneal ulcers. Careful examination of the palpebral conjunctiva using double eversion to look for foreign bodies or keratinization should also be performed. External examination of eyelid abnormalities, the degree of lagophthalmos, and assessment of corneal sensitivity are critical in determining what type of tarsorrhaphy is appropriate (permanent vs. temporary) and deciding on the extent of tarsorrhaphy (lateral vs. medial vs. central vs. total) to be performed. The length of tarsorrhaphy to be performed is determined by gently pinching the upper and lower eyelids together with forceps or manually to achieve desired closure. Tarsorrhaphy is a safe and relatively simple procedure in which part, or all the upper and lower eyelids are joined together to cover the eye partially or completely. Tarsorrhaphies are highly effective in the management of nonhealing epithelial defects and other corneal surface pathology by creating a more hospitable environment for corneal healing. [1] Tarsorrhaphies can be permanent or temporary, total or partial, and can be further classified into short duration tarsorrhaphies without sutures, temporary suture tarsorrhaphies, permanent suture tarsorrhaphies, and more extensive tarsorrhaphies that involve mobilization of skin or tarsal plate flaps. [2] Three bolsters of the surgeon's choice of size and material (plastic tubing, red robin catheter, cotton wool balls, etc.) are prepared. Lagophthalmos due to facial nerve palsies (neurogenic exposure keratopathy), cicatricial damage to the eyelids, anorexia nervosa, leprosy, Ramsay Hunt Syndrome Type 2, orbital tumors, and thyroid eye disease [1] [7] [8] [9]

Kasaee A, Musavi MR, Tabatabaie SZ, et al. Evaluation of efficacy and safety of botulinum toxin type A injection in patients requiring temporary tarsorrhaphy to improve corneal epithelial defects. Int J Ophthalmol. 2010;3(3):237-240. doi:10.3980/j.issn.2222-3959.2010.03.13.

Scissor - Westcott, Curved, Sharp, Length 11cm

The mucocutaneous junction of the posterior lamella of the lower lid is excised using Westcott scissors. At OfficeStationery, we know a good quality pair of scissors is vital in any office or working environment. The best multi purpose scissors are titanium bonded scissors. These are strong but lightweight which makes them easier scissors to cut with. We have a huge range of these, as well as those with stainless steel blades. These are all manufactured by big brands including Scotch, Wescott, Leitz, Durable and more, which guarantees you the best quality every time. Cosar CB, Cohen EJ, Rapuano CJ, Maus M, Penne RP, Flanagan JC, Laibson PR. Tarsorrhaphy: clinical experience from a cornea practice. Cornea. 2001 Nov;20(8):787-91. doi: 10.1097/00003226-200111000-00002. PMID: 11685052.

The needle is then turned around and passed 3-4 mm below the lower lid skin, through the lid margin and retrieved from the meibomian gland orifices. The needle is then passed through the meibomian gland orifices of the upper lid margin and retrieved 3-4 mm above the upper lid margin and engages the upper bolster. Fu L, Patel BC. Lagophthalmos. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 10, 2020.The needle is then passed through the upper lid skin 3-4 mm above the lid margin, exiting through the meibomian gland orifices. Made in premium quality stainless steel with satin finish to reduce glare. The instrument can be sterilized and reused. Specialty Allen, R. “Temporary bolster tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library.