The Ophthalmic Office Procedures Handbook

CHAPTER 7

117

Eyelid Biopsy

INFORMED CONSENT CONSIDERATIONS Informed consent with the patient’s signature and witnessed by someone other than the patient is essential before this procedure. The patient should be aware of what other options are avail able besides a lid biopsy in the office today: ● Alternative options besides biopsy include: ◗ Return on a separate date in the future that is more convenient for the patient to have the biopsy. ◗ Observe the lesion for growth or changes, and schedule a return appointment in 6 months. ◗ Referral to an eyelid surgeon for opinion and treatment ◗ Topical treatment with antibiotic and/or steroid ointment to see if the lesion responds. The clinician’s medical judgment may determine whether this will or will not be effective. Informed consent should have a description of the procedure in simple words for nonmedi cal individuals to understand. For example, “This procedure is a lid biopsy to remove either in part or completely an abnormal growth on the eyelid. If indicated, the lesion may be sent to pathology for identification.” On the form, an explanation of the procedure should be included verbally or in writing, with possible risks and benefits listed verbally and in written form. The clinician might say, “Once in a reclined position, a drop of topical anesthetic will be placed in the eye closest to the eyelid lesion to be removed. The area will be cleaned with either povidone–iodine antiseptic or other antiseptic solution to help prevent infection. An injection will be given in the eyelid near the lesion, which will numb the lid so the rest of the procedure will not hurt. The discomfort from the injection will last about 10 sec onds. There will be burning and some discomfort during those 10 seconds. The lesion will be biopsied, and the oozing stopped with a cautery. The cautery can have unusual or sometimes unpleasant smell, like burnt hair or protein. If indicated, sutures may be used to close the area, but usually there will be a scab that has to heal over the next week or so. You may swell and bruise that can last up to 2 weeks, but usually resolves within a few days.” ■ History of vasovagal episode with fainting at the sight of needles or minor procedures ■ Patient is on chronic oxygen and not able to be off for even a short period of time. (Supplemental oxygen is flammable with cautery use.) ■ History of the patient being intolerant of lying flat or slightly reclined ■ Allergy to any local anesthetic or supplies to be used, including latex if latex-free sup plies not available ■ History of bleeding. Many patients are on medications that thin the blood. Usually, biopsies can be performed safely in the office even if the patient remains on their blood thinners. Epinephrine in the local anesthetic will constrict blood vessels in the area after 10 to 15 minutes of being injected and help control bleeding. However, if there is a history of bleeding disorder or perfuse bleeding when the patient gets a cut or is nicked, the clinician may want to refer the patient to a specialist for further treat ment. If it is desired for the patient to stop a blood-thinning medication prior to the biopsy, medical clearance from the patient’s doctor is indicated.

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