When deciding whether or not the patient needs a tarsorrhaphy, it is helpful to think of the reasons for corneal decompensation. If the problem lies with the ocular surface, can it be managed with aggressive lubrication, medications, or scleral contact lenses? If the patient has paralytic lagophthalmos, would a gold weight or Botox to the upper eyelid be preferable? Is corneal protection required temporarily or long-term? What part of the eyelid requires closure? It is important to rule out infection prior to performing a tarsorrhaphy. Make sure that the tarsorrhaphy does not completely cover the eye if serial examinations are needed or eye drops are necessary. Also take into consideration that there may be a significant risk of amblyopia depending upon the patient’s age and the size of the tarsorrhaphy.