Tisseel, a commercially available fibrin biosealant, has been used in Europe for more than 25 years and new indications are constantly being described. We wish to highlight several innovative uses of Tisseel in oculoplastic and lacrimal surgery based on what has been published in the literature to date. We also present our experiences with the fibrin glue, with pre- and post-procedure images.

Medial canthal basal cell carcinomas are often difficult to manage cosmetically due to the surface concavity in the region and can result in bow-string scars. We have found that a modified Laissez approach using Tisseel allows for better approximation of wound margins on glue contraction, provides scaffolding for re-epithelialization and acts as biological bandage.

In patients with recurrent dacryocystitis who are either unfit for or decline any major intervention, we instead flush the mucocoele with cefuroxime and pack it with Tisseel. This technique prevents further recurrence of dacryocystitis but does not address the epiphora.

When initially attaching a free full thickness skin graft to the recipient bed we use Tisseel glue prior to suturing. This reduces the formation of haematomas and seromas, and possibly results in a less ‘bulky’ scar.

Finally, we would like to present a modified version of anterior lamellar repositioning using Tisseel instead of the traditional sutures to secure the anterior lamella to the posterior lamella. It achieves a more evenly distribution of forces and smoother eyelid eversion. This new surgical technique has not been previously described and allows for an improved cosmetic outcome and reduced surgical time.

No postoperative complications were seen. In all cases, we had excellent cosmetic outcome and high patient satisfaction

Tisseel has been used in adnexal and lacrimal surgery with success and our experiences at our unit support this. Tisseel improves surgical efficiency, cosmetic outcome and patient satisfaction.