The Ophthalmic Office Procedures Handbook

SECTION 3 Lids, Lashes, and Adnexa

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4. Ice on and off the first day can help decrease swelling. 5. Oral antibiotics are only indicated if the patient’s health history makes them more prone to infections. 6. The patient needs to be aware that there may be a bruise or swelling that can take up to 2 weeks to go away. 7. Avoid rubbing the eyelids or pulling on the lids. Sometimes the area can itch as it is healing. 8. Signs to be aware of: increased redness or swelling, discharge, increasing pain, and bleeding that cannot be controlled with ice and pressure on the lid. No lifting over 10 pounds or bend ing over at the waist for a week if a patient is having some problems with oozing or bleeding. Most patients can resume all normal activities that day, including lifting and bending. 9. Follow-up is not needed for most biopsies. Patient should know to call if they have any concerns. POTENTIAL COMPLICATIONS AND THEIR TREATMENT

Key Potential Complications ■ Postoperative infection ■ Persistent bleeding ■ Scar or lid notch formation ■ Lash loss

The most common complication of an eyelid biopsy is infection . If an infection occurs, oral cephalexin 500 mg three times a day or oral clindamycin 300 mg three times a day treats most postoperative cellulitis. Be sure to ask the patient if they are allergic to any medications. Sometimes patients are very lax in filling out paperwork for eye doctors, thinking that general medical information is not important for the eye doctor. Patients may present after the procedure with bleeding , especially those on blood thinners or with poorly controlled hypertension. Usually, bleeding can be controlled with ice and tam ponade. Pressure is not to be placed on the eye, but on the eyelid area. Sometimes additional cauterization is required. Usually, local anesthetic is injected first followed by cauterization. If it cannot be controlled, the patient may need to be referred to a specialist or to the emergency room. This is a rare occurrence. As the area heals, the patient may be dissatisfied with the scar or a lid margin notch. Allow at least 3 months for the area to heal. Occasionally, a steroid ophthalmic ointment can be of benefit for undesirable scars. Avoid using scar-reducing creams or gels that are not approved to be used around the eye. Having a photograph of the lesion is helpful to remind the patient what the lid looked like before the removal of the lesion. If this does not satisfy the patient, refer to a specialist. If the scar is causing lid malposition, refer to an oculoplastics specialist. Lash loss in the area can be a complication. The patient should be made aware that this is a possibility. Occasionally, lash-growing products like bimatoprost (Latisse) can help if there are any functioning lash follicles left.

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