title: Treatment of refractory exposure keratitis with modified medial tarsorrhaphy using tarsoconjunctival flap.
abstract: BACKGROUND
  This study reports the surgical technique of modified medial tarsorrhaphy using tarsoconjunctival advancement flap for treatment of exposure keratitis secondary to incomplete lid closure combined with ocular dysmotility or decreased corneal sensation.
  
  
  METHODS
  Three patients suffered from intractable exposure keratitis due to incomplete lid closure with ocular motility limitation or decreased corneal sensation, even after the lateral tightening procedure. Because they did not want a cosmetically unacceptable appearance by permanent tarsorrhaphy, modified medial tarsorrhaphy using tarsoconjunctival advancement flap was performed. Clinical manifestation and surgical outcome were investigated through retrospective chart review.
  
  
  RESULTS
  The minimum follow-up period was 10 months. All patients showed successful surgical results. Ocular symptoms were satisfactorily treated, corneal re-epithelialization was achieved and maintained during the follow-up period, lagophthalmos improved, and all patients were satisfied with their appearance.
  
  
  CONCLUSIONS
  We describe modified medial tarsorrhaphy with tarsoconjunctival advancement flap which was effective in treatment of severe exposure keratitis with incomplete lid closure in patients who elected not to have cosmetically problematic, permanent corrective surgery.
authors.affiliation: Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, South Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Jang
authors.forename: Jin Sook
authors.initials: JS
authors.lastname: Yoon
mesh_terms: D000368:Aged; D003228:Conjunctiva / Q000601:surgery*; D019573:Epithelium, Corneal / Q000502:physiology; D005141:Eyelid Diseases / Q000150:complications; D005143:Eyelids / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007634:Keratitis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000150:complications; D013508:Ophthalmologic Surgical Procedures; D062326:Re-Epithelialization / Q000502:physiology; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult