The Ophthalmic Office Procedures Handbook



Eyelid Biopsy

Incisional Biopsy: Punch Biopsy A punch biopsy is a type of incisional biopsy, although it can be an excisional biopsy if the lesion is smaller than the diameter of the punch tool available. A 2- to 3-mm punch biopsy tool is recommended on the eyelid. If it is used for diagnosis of a possible malignancy, the area biopsied should be at the outer edge of the lesion and not in a necrotic center. A small sample is taken and then examined under a microscope by a pathologist. Punch biopsies are rarely performed on the lid margin. The defect is a complete circle and results in lid notching. It works well with periocular lesions: small (excisional) or large (incisional for diagnosis). Punch biopsy tools come in different sizes. The end of the tool has a sharp metal circle. The end is placed on the skin, and the clinician gently rotates it clockwise and counterclockwise, pushing down with a little pressure to cut the skin. Usually, the biopsy is about 3 to 4 mm in depth. The doctor needs to remember that the eyelid skin is the thinnest in the body and that care 2. The punch biopsy tool has been placed on the sterile field. It is grasped by the handle and placed on the skin that is to be biopsied. If excisional, the punch surrounds the lesion. 3. The tip is flush with the skin. The doctor rotates clockwise and counterclockwise with slight pressure. The tool is removed, and the specimen is grasped with a forceps and el evated. The base of the biopsy will need to be cut with scissors. 4. Hemostasis is obtained with thermal cautery energy. 5. Sutures are not used with a punch biopsy. POSTOPERATIVE CARE/COMANAGEMENT (FOLLOW-UP SCHEDULE) must be observed to not go too deep into the tissue. 1. Steps 1 to 8 as listed earlier under excisional.

Key Postoperative Considerations ■ Topical ophthalmic antibiotic, once or twice daily for 1 week ■ Ice on and off to decrease swelling ■ Watch for signs of infection

After the procedure, the face is cleaned, removing the cleaning solution and any blood. The skin area is dried. 1. A topical ophthalmic antibiotic is recommended at least once or twice a day for the first week. Erythromycin ophthalmic ointment is inexpensive and covers many skin infections and is therefore often used. If available, place it on the patient before correcting the chair to the sitting position. 2. Have the patient wait a few moments in the sitting position to be sure they feel good before allowing them to get up and walk. Less stable patients may need assistance. 3. Makeup over the scab or incision/sutures is avoided until the area heals. This is usually 2 weeks. Makeup can be worn on the face away from the area, but the patient must be careful in removing the makeup so as not to rub harshly the biopsied area.

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