The Ophthalmic Office Procedures Handbook



Eyelid Biopsy

technique. The sterile wrap around the instruments can serve as the sterile cover base on which to place any other supplies. Also, cotton applicators, gauze pads, and cautery should be opened and placed sterilely. If there is uncertainty whether suture will be used, have it ready, but not opened until sure it is needed. It is the most expensive disposable supply used in office-based lid biopsies. The method to clean the area needs to be made available. Some pour povidone–iodine solu tion onto gauze pads on the sterile field to use for cleaning. Others use prepackaged povidone– iodine swab sticks or pads. The benefit of this is that the area can be prepped using nonsterile gloves holding just the handle of the swab, using only one pair of sterile gloves for the biopsy itself. This reduces overhead because sterile gloves are more expensive. Once the area is clean, the procedure can begin. PROCEDURE Excisional Biopsy: Complete Lesion Removal The lesion has been identified to be biopsied and has been documented. The patient has been informed of the risks, benefits, and alternatives of the procedure. The consent has been signed and witnessed. Excisional biopsy is recommended for non-lid margin lesions (Figure 7-6). It can be performed on lash line lesion; however, it may cause loss of lashes. It is usually recom mended for periocular areas of the lids, away from lashes or margins. 1. Area to perform the procedure has been prepared with appropriate supplies and equipment as described earlier. 2. Patient is brought to the procedure chair. The patient is informed the chair will be moved back into a reclined position. Be sure the patient is comfortable to be here for a few minutes. Some patients will need a pillow placed under their knees to take pressure off their back. 3. If the lesion is small or flat, the clinician may want to mark it with a surgical marker. Some times after the local anesthetic is given, it is hard to identify the growth. 4. Topical anesthetic drop placed in the eye that is on the same side of the lesion. 5. Ice or numbing cream can be applied. Either can take a few minutes to be effective. Ice works quicker than the numbing cream usually. (Some offices purchase logo-branded small circular ice packs that can be reused by the patient. It also is advertising for the office.) 6. Surgical lamp or light is adjusted to give maximal lighting. The patient should be warned that a bright light is about to shine, ask them to please keep their eye closed without squeezing the lids. 7. The clinician or technician puts on a set of gloves and preps the area with povidone–iodine swabs or solution. Povidone–iodine scrub is more toxic to the eye and should not be used around the eye. The sterile swabs can be opened and used with nonsterile gloves. If alcohol is used, it must be allowed to dry completely prior to using a cautery. Alcohol is flammable and if not allowed to dry can cause a fire and burn the patient or clinician. Alcohol is color less, and the area that was prepped cannot easily be identified whereas povidone–iodine has a yellowish color and allows the clinician to know what areas have been treated. 8. The clinician informs the patient that they will feel an initial stick and a burning sensation. Ask the patient to try not to move or squeeze the eyelids closed. Squeezing can increase bruising from the injection. The patient needs to be aware that the discomfort will only

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