The ideal tarsorrhaphy for corneal protection is one that meaningfully protects the cornea, is cost and time efficient, low maintenance, without significant adverse effect profile, and can be readily reversed. There are numerous approaches that have achieved various combinations of these traits. However, historically the reversible techniques often had a tradeoff of ease versus effective corneal coverage (such as with tape), or are reversible only in a relative sense (such as suture tarsorrhaphies).

The proposed technique in this study is a variation of similar dynamically reversible tarsorrhaphies. These include the drawstring temporary tarsorrhaphy [5] or the zipper tarsorrhaphy [11]. In our technique, the use of only two bolsters is a faster and simpler technique compared to the drawstring tarsorrhaphy. It possible to eliminate the need for the 3rd bolster due to passing the suture through and through the IV tubing resulting in more friction and thus more control in the final result. Additionally our use of IV tubing compared is readily available in the clinic setting, compared to some techniques such as the zipper tarsorrhaphy10 that require rubber urinary catheters.

Reversibility is an important feature for regular exams and treatment by physicians, eye drop application by patients and family members, and allowing the patient breaks from total occlusion of the eye, all this while offering corneal protection. In our study population, this was most pertinent to patients with keratouveitis for whom eyelid protection of the cornea alone was not sufficient, as they also required active topical therapy for inflammation. Additionally reversibility can be valuable in the intensive care unit setting or elderly patients in which hospitalization induced delirium and fatigue from disrupted circadian rhythms is a risk.

Patients and their caregivers demonstrated capacity and comfort in the clinic with opening and closing our caregiver tarsorrhaphy. Future directions include comparative study of ophthalmic outcomes, as well as subjective measures of patient/caregiver comfort and satisfaction with the reversibility feature.

Overall our proposed variation of the reversible tarsorrhaphy was safe, efficient, had good longevity, and appeared effective in corneal protection.