What is Tarsal Plate Sparing
Tarsal plate sparing refers to a surgical technique that preserves the integrity of the tarsal plate during eyelid procedures to maintain the structural support and normal function of the eyelid.
Anatomy and Function of the Tarsal Plate
The tarsal plate is a fibrocartilagenous structure within the eyelid that provides essential structural support and physical form 1. It serves as the fibrocartilaginous skeleton of the eyelid with the following characteristics:
- Located in both upper and lower eyelids
- In the upper eyelid, it has a vertical height of approximately 10.6 mm centrally, 7.8 mm laterally, and 6.2 mm medially 2
- The width of the upper tarsal plate averages 37.6-38.5 mm 2
- Comes in three distinct shapes: sickle (48%), trapezoid (28%), and triangular (24%) 2
- Has an elastic modulus of 1.73 MPa, indicating its specific biomechanical properties 1
Importance of Tarsal Plate Sparing
Preserving the tarsal plate during eyelid procedures is critical for several reasons:
- Structural integrity: The tarsal plate maintains eyelid shape and prevents malposition
- Protection of the cornea: Proper eyelid function depends on tarsal plate integrity
- Prevention of complications: Preserving the tarsal plate helps avoid:
- Eyelid malposition (ectropion, entropion)
- Scleral show
- Corneal exposure
- Lagophthalmos (incomplete eyelid closure)
Clinical Applications of Tarsal Plate Sparing
Tarsal plate sparing techniques are employed in various ophthalmic and oculoplastic procedures:
1. Blepharoplasty
When performing blepharoplasty on patients with atonic lower lids or those at risk for ectropion, tarsal plate preservation is essential 3. In some cases, controlled tarsal plate resection may be performed for specific indications, but complete preservation is generally preferred.
2. Eyelid Reconstruction
After traumatic injuries, congenital anomalies, or tumor excisions, preserving or reconstructing the tarsal plate is crucial for maintaining normal eyelid function 2.
3. Correction of Eyelid Malposition
The tarsal strip technique is used to correct lower eyelid malposition while preserving the tarsal plate structure. This technique has shown good aesthetic and functional results in patients with scleral show and ectropion 4.
4. Temporary Tarsorrhaphy
In temporary tarsorrhaphy procedures, sutures can be placed through the tarsal plates of the upper and lower eyelids to provide corneal protection without disrupting eyelid margin anatomy 5.
Potential Complications of Not Sparing the Tarsal Plate
Failure to preserve the tarsal plate during eyelid procedures can lead to:
- Eyelid contour abnormalities
- Eyelid margin distortion
- Lash growth disturbances
- Corneal exposure and subsequent keratopathy
- Dry eye syndrome due to poor lid apposition
- Conjunctivitis and other ocular surface disorders 6
Conclusion
Tarsal plate sparing is a fundamental principle in eyelid surgery that preserves the natural anatomy and function of the eyelid. Understanding the biomechanical properties and anatomical variations of the tarsal plate is essential for successful oculoplastic and reconstructive procedures to maintain both the functional and aesthetic aspects of the eyelids.