This is Richard Allen at the University of Iowa. This video demonstrates a medial tarsorrhaphy. A thermal cautery, or the cutting instrument of the surgeon’s choice, is used to make an incision just inferior to the eyelid margin medial to the punctum through the skin and orbicularis muscle. This incision extends to the medial canthus and continues along the upper eyelid in the same manner. Dissection is then carried out between the anterior and posterior lamella along the length of the V incision with Westcot scissors. The posterior lamella of the upper and lower lid are sutured together with interrupted 6-0 vicryl sutures. Care is taken not to make this pass too deep so that the canaliculus is not damaged. Usually only 2-3 sutures are needed. The anterior lamella is then sutured together with interrupted 7-0 vicryl suture. These anterior lamellar sutures should not be placed too far medial or a web would be produced.