The Ophthalmic Office Procedures Handbook

SECTION 3 Lids, Lashes, and Adnexa

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● Periocular skin lesions The recommended procedure would be excisional with or without suture closure. If the lesion is large and entire removal may cause the lid to pull down or away from the eye, then an incisional biopsy to get a diagnosis may be appropriate. This biopsy is removing some of the tissue, but not attempting to remove the lesion totally. A punch biopsy can be used in the periocular area to remove a small lesion totally (excisional) or to perform an incisional biopsy for diagnosis. A punch biopsy should not be used on a lid margin and is rarely used on a lash line lesion. The biopsy leaves a circular defect and could easily cut deeper than the clinician would desire on the lid margin and would leave a notch. INDICATIONS Key Indications ■ Signs/symptoms of malignancy ■ Patient concern ■ Future eyelid malposition if there is growth ■ Lesion location ■ Any lesion with loss of lashes, change of eyelid architecture, bleeding, ulceration, increasing pigmentation, rapid growth ■ Patient has irritation, visual obstruction, concern for malignancy ■ Lesion that causes lid malposition due to size or location ■ Lesion location is such that growth in the future may cause a problem for the patient. It is easier to remove a small lesion than when it has grown and may then need more aggressive surgery to close the skin/muscle defect. The most common reason for a lid biopsy in the office is to remove a lid lesion that is both ering the patient in some way. The patient may see it in the mirror, experience irritation, or find it unsightly. Occasionally, the examiner will notice a lesion that the patient has not even known was there. Any suspicious characteristics, such as those that were discussed previously, warrant a biopsy to identify whether the lesion is benign or malignant. CONTRAINDICATIONS

Key Contraindications ■ Allergy ■ History of bleeding ■ History of vasovagal episode ■ Chronic oxygen use ■ Patient unable to lay flat

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