When the occasion arises to make a temporary or permanent partial closure of the eyelids, I place the attachment (Figure) at the junction of the middle and lateral thirds. This point gives maximum protection to the cornea during sleep with the eye turned up and out. When the eyes are "open," the inner two thirds of the palpebral apperture is available for seeing with the eyes in the primary position and in the position of convergence. The single attachment stretches somewhat with time so that the lash lines separate and give a minimal cosmetic defect. The small lateral opening may be used for irrigating the eye if necessary.
The procedure for performing the closure is to place the two lids in a clamp with the lid edges nearly touching. A 5-mm length of lid margin is removed above and below. Needles are passed deep, but not through the conjunctiva. The
HILDRETH HR. Tarsorraphy. Arch Ophthalmol. 1966;75(1):91. doi:10.1001/archopht.1966.00970050093019