Permanent tarsorrhaphy. A, A vertical intermarginal incision (between tarsus and orbicularis muscle) is made through the gray line of the upper and lower eyelids (using a #11 blade); care should be taken not to incise into the tarsal plate. B, View of the tarsus of the upper and lower eyelids. C, A double-armed mattress suture (6-0 polyglycolic acid) is then passed through the lower and upper tarsal plates, with the sutures 4–5 mm from each other and 3 mm from the edge in a lamellar fashion. The suture should not be placed through the full