The Ophthalmic Office Procedures Handbook



Eyelid Biopsy

Also, if the lesion is benign, the patient may return with another lesion and think it is a recur rence of the same lesion, but documentation may show it is a new lesion. It also may support why the lesion was removed. If the patient opts for observing the lesion, a photograph allows comparison for the return visit. Having the patient place ice to the lid will help decrease the discomfort of the injection. Some offices use a numbing cream like topical lidocaine, but that usually takes 15 minutes or more to take effect. Many patients are on aspirin or some blood thinners. In fact, few patients older than 60 years are not on some sort of blood-thinning medicines: aspirin, nonsteroidal anti-inflam matories, clopidogrel (Plavix), warfarin (Coumadin), apixaban (Eliquis), and so on. Biopsies can be performed on these patients without taking them off their blood-thinning medicines, which were prescribed to prevent the worsening of health issues. If there is a concern, refer the patient to a specialist or obtain medical clearance for the patient to be off the concerning medication prior to the biopsy. Supplies (Figures 7-4 and 7-5) ● Topical anesthetic for the eye (proparacaine 0.5% or tetracaine 0.5%) ● Nonsterile or sterile surgical marking pen—fine point ● 3-mL syringes ● 30- to 32-gauge needle ● Larger gauge needle to draw up local anesthetic ● (8–27 gauge) or sterile cap made for drawing local anesthetic from the bottle ● 1% lidocaine with 1:100,000 epinephrine ● Sterile nonlatex surgical gloves in appropriate size ● Povidone–iodine antiseptic swabs or solution pads (do not use povidone–iodine scrub around the eyes.) ● Sterile 4 × 4 gauge pads ● Sterile cotton tip applicators ● Sterile scissors (e.g., Westcott or Vannes) ● Sterile forceps with teeth (e.g., 0.5 or Bishop Harman forceps) ● Sterile needle driver (e.g., Castroviejo) ● High-temperature 2,200-degree battery cautery (e.g., brand Bovie) or something for hemostasis ● Suture if needed (5-0 fast absorbing gut is usually the best to have in office.) ● Disposable No. 10, No. 11, or No. 15 surgical blade and handle ● Punch biopsy tool (Recommend a 2- to 3-mm diameter cutting circle for eyelids.) ● Small chalazion clamp ● Pathology specimen containers with formalin and pathology request sheets with identifica tion labels ● Autoclave to clean instruments and sealed bags or trays in which to store sterilized instruments ● Good lighting to perform the procedure ● A chair that will recline the patient to almost supine, but with head higher than the heart and feet. (Reverse Trendelenburg: foot down, head up supine position)

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