Skip to main content
  • Residents Resident Edition Education

    Ophthalmic Suturing 101

    Add to My Bookmarks

    Even in an age of sutureless cataract surgery, knowing how to suture is still an essential skill that every eye sur­geon should master. Part of that skill set involves deciding which suture to use. In addition to the basic options, this guide (see tables and slideshow below) will also discuss some basic suturing techniques that will help you develop your skills regardless of the tissue you’re working with. Take advantage of wet lab resources; your suturing will get better with practice, and the better you are, the more opportunities you’ll get in the OR.

    When you’re on call, you may find that not every location has the sutures you need. Make it a point to know what is available and if they’re not, either ask for them to be ordered or bring your own. The last thing you want to be doing on call is looking for equipment.

    Table 1. Suture Type

    Brand Name Material Duration of Wound Support Common Uses
    Absorbable
    Fast Gut  Beef serosa or sheep submucosa 7 days Superficial skin
    Plain Gut  Beef serosa or sheep submucosa 7-10 days Superficial skin
    Chromic Gut  Beef serosa or sheep submucosa 21 days Subcutaneous tissue
    Vicryl  Polygalactin 910 21 days Subcutaneous tissue, muscle reattachment, conjunctiva, cornea
    Non-Absorbable
    Ethilon  Nylon NA Cornea, sclera, skin
    Prolene  Polypropylene NA Superficial skin
      Silk NA Traction sutures, lid margin

    Table 2. Suture Size

    Size Common Uses
    10-0 Cornea
    9-0 Limbus, conjunctiva
    8-0 Sclera
    7-0 Muscle reattachment, conjunctiva, eyelid skin
    6-0 Eyelid skin, traction sutures, muscle surgery
    5-0 Brow, facial skin, levator advancement

    Table 3. Needle Types

    Name Symbol Description Common Uses
    Tapered Tapered Cuts at the point and leaves behind the smallest hole surrounding the suture Conjunctiva when you need a water-tight seal (e.g., trabeculectomy closure)
    Cutting Cutting Cuts on the inside curve Some plastics uses; overall not common
    Reverse Cutting Cutting Cuts on the outside curve Plastics, skin
    Spatulated Spatulated Cuts on the lateral edges of the needle rather than the curve Most common type of needle used for suturing sclera and tarsus

    * * *

    Jason D. Rupp, MD, PhDAbout the author: Jason D. Rupp, MD, is a glaucoma and advanced anterior segment surgeon in private practice at Clarus Vision Clinic in Salt Lake City. Dr. Rupp completed his residency and fellowship training at Washington University in St. Louis. He joined the YO Info editorial board in 2016.