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

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Ellis MF, Daniell M. An evaluation of the safety and efficacy of botulinum toxin type A (BOTOX) when used to produce a protective ptosis. Clin Exp Ophthalmol. 2001;29(6):394–399. 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. 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.

Donnenfeld ED, Perry HD, Nelson DB. Cyanoacrylate temporary tarsorrhaphy in the management of corneal epithelial defects. Ophthalmic Surg. 1991;22591- 593. Especially includes narrow blades which increase precision. Moreover, the instrument has curved blades that contort to the surface of the eye for increased accuracy. To retain a prosthesis, Boston Keratoprosthesis, or other device in patients with anophthalmia or after evisceration or enucleation In summary: The suture is passed through the bolster, followed by the upper eyelid, then the lower eyelid, then the second bolster. Once the second bolster is engaged, the suture is turned around and placed through the second bolster, then the lower eyelid, then the upper eyelid, and the bolster. The suture is then tied to complete the tarsorrhaphy. [12]Our Westcott Tenotomy Scissor comes with rounded tips that are ideal for blunt dissection of tissues. If the eye needs to be opened the smaller bolster is separated from the larger lower eyelid bolster, which allows the eyelid to be examined or to receive treatment 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. In addition, the operating scissor includes fine serrations to improve grip. It also has small blades to shank ratio for better control. Allen, R. “Pillar tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library.

The suture is then tied over the bolster to complete the tarsorrhaphy. The suture should be snug to prevent incomplete lid opposition when intraoperative edema resolves.

Scissor - Westcott, Straight, Sharp, Length 11cm

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

The mucocutaneous junction of the posterior lamella of the lower lid is excised using Westcott scissors. Allen, R. “Lateral tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library. 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. Khairy H. Botulinum toxin A-induced ptosis: A safe and effective alternative to surgical tarsorrhaphy for corneal protection. Journal of the Egyptian Ophthalmological Society. 2014;107(1):20-22. doi:10.4103/2090-0686.134937. 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.

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. Allen, R. “Temporary bolster tarsorrhaphy.” Oculoplastics Surgery Techniques. University of Iowa Health Care. Ophthalmology and Visual Sciences Video Library. The needle is then passed through the upper lid skin 3-4 mm above the lid margin, exiting through the meibomian gland orifices. 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.