Suture tarsorrhaphy system to control keratopathy after ptosis surgery.

Four tarsorrhaphy sutures are placed through the lower eyelid and brow following ptosis surgery in a system designed for patients with external ophthalmoplegia, third nerve paralysis, and myashenia gravis. Three of the sutures connect the lower eyelid to the forehead, and the fourth suture is passed through the lower eyelid and taped to the cheek. The three lid-brow sutures are released during the first two postoperative weeks, one by one, and topical ointment instillations are gradually tapered. The tarsorrhaphy system allows the cornea to adapt gradually to the lagophthalmos that follows ptosis surgery. It also keeps the eyelids partially closed during the first two postoperative weeks in patients with frontalis sling surgery who have marked difficulty lowering their eyebrow and closing their eyelids because of early postoperative forehead edema and pain. The tarsorrhaphy system has prevented serious keratopathy in six patients with ptosis associated with abnormal ocular motility and in one patient with lagophthalmos following trauma. It also allowed the six ptosis patients to have full, rather than partial, correction of their ptosis.