Fu L, Patel BC. Lagophthalmos. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 10, 2020.

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 Technique The posterior lamellae of the upper and lower lids are sutured together using 5-0 or 6-0 Vicryl suture in interrupted fashion.

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Illustration of a Pillar tarsorrhaphy step-by-step approach. Image c reated by by Fabliha A. Mukit, MD using an iPad and the Procreate app. Technique A #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. A #11 or #15 Bard-Parker blade is used to make an incision along the grey line of the lateral lower lid of the desired length to a depth of 2 mm. To retain a prosthesis, Boston Keratoprosthesis, or other device in patients with anophthalmia or after evisceration or enucleation

Two bolsters of the surgeon's choice of size and material (plastic tubing, red robin catheter, cotton wool balls, etc.) are prepared. If it is anticipated that the suture will be removed within 2 weeks and there is no skin compromise, bolsters may not be necessary.

Scissor - Dressing, Blunt/sharp blades, Length 13cm

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. After washing and preparing the eye thoroughly within the lid margins and fornices, the glue gel of choice is applied along closed lateral eyelid margins using the standard applicator tip supplied with the gel. Using the same applicator tip, the gel is spread medially along the eyelid margins to achieve the desired amount of closure. The glue is allowed to dry for 15 – 20 seconds. Once dry, the eyelids stay closed for approximately 2 weeks. [5] [16] Some report longer lasting closure with a recent study in a pediatric population reporting that cyanoacrylate glue tarsorrhaphies last an average of 4.5 weeks (range 0.5-13 weeks). [17] It can be reversed by cutting the eyelashes following the application of lidocaine gel. Lee V, Currie Z, Collin JRO. Ophthalmic Management of Facial Nerve Palsy. Eye. 2004; 18: 1225-1234. A #15 Bard-Parker blade is used to cut through the skin and orbicularis adjacent to the canaliculus.