67882 Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate

Name of the Procedure:

Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate

Summary

This surgical procedure involves manipulating the eyelids to create adhesions (joining of tissues) between specific midpoints or corners. This may include transposing (repositioning) a part of the tarsal plate, a dense connective tissue that supports the eyelid structure, to achieve functional and aesthetic results.

Purpose

• Medical Condition: Addresses conditions like corneal ulceration, exposure keratopathy, or facial nerve palsy.
• Goals: To protect the cornea, prevent further damage, and improve eyelid function.

Indications

• Symptoms like chronic eye pain, irritation, or inability to close the eyes fully.
• Conditions such as eyelid malposition, facial nerve paralysis, or chronic corneal exposure.
• Patients unresponsive to conservative treatments like lubricating eye drops and eye patches.

Preparation

• Pre-procedure Instructions: Patients may need to avoid eating or drinking for several hours before surgery, depending on the anesthesia plan.
• Diagnostic Tests: Eye examinations and imaging studies to assess the structural damage and plan the surgery appropriately.

Procedure Description

1. Anesthesia: Local or general anesthesia is administered depending on the extent of the procedure and patient comfort.
2. Incisions: Small incisions are made on the eyelid to access the tarsal plate.
3. Transposition of Tarsal Plate: The surgeon repositions a portion of the tarsal plate to create desired adhesions.
4. Construction of Adhesions: Techniques are applied to adhere sections of the eyelid margin either at the midpoint or towards the corners to stabilize the eyelid position.
5. Closing Incisions: The incisions are closed with sutures, and antibiotic ointment may be applied.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity.

Setting

Performed in a hospital or an outpatient surgical center equipped for ophthalmologic procedures.

Personnel

• Ophthalmic surgeon
• Surgical nurses
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Common Risks: Infection, bleeding, and temporary swelling.
• Rare Complications: Scarring, eyelid malposition, or vision changes. Additional surgery may be needed to correct any issues.

Benefits

• Expected Benefits: Enhanced protection of the cornea, prevention of further eye damage, and improved eyelid function.
• Realization Time: Patients may notice improvements within a few weeks, although complete healing could take longer.

Recovery

• Post-procedure Care: Application of prescribed eye ointments, cold compresses to reduce swelling, and pain management medications.
• Recovery Time: Typically, recovery takes a few weeks, with follow-up appointments to monitor healing.
• Restrictions: Avoid rubbing the eyes and strenuous activities until cleared by the surgeon.

Alternatives

• Other Treatments: Eyelid weights, botulinum toxin injections, or use of moisture shields.
• Pros and Cons: Non-surgical treatments may offer temporary relief but are less invasive; however, surgical options like tarsorrhaphy provide more definitive solutions but come with higher risks and longer recovery times.

Patient Experience

• During the Procedure: Patients may feel mild discomfort if under local anesthesia but will not feel pain.
• After the Procedure: Some swelling, bruising, or irritation is common, managed by medications and follow-up care.