Indications
- remove lump
- cosmetic purposes
Differential diagnosis
- other benign and malignant eyelid tumors
Alternative therapy
wait/IPL treatment
Preoperative
- diagnosis (including good quality pictures)
- consent form
- always mention risk of residual lesion, scarring and recurrence
- +PLUS (private self-pay costs): consider offering adjuvant therapies such as Meibomian gland treatment with IPL to prevent recurrence
- anticoagulation: adjust antiplatelet or anticoagulant medication if possible (stop Aspirin® 10 days before surgery; Marcoumar® INR >= 1.2 on the day of surgery; new anticoagulants (Eliquis®, Lixiana®, Xarelto® etc.): stop 2 days before, on the day of surgery and 2 days after surgery)
Preparation
- preoperatively: check that anticoagulation has been stopped, clean skin, no creams, no make-up
- 3x Tetracaine SDU® 1% eye drops (every 5 minutes)
- cleanse skin with alcohol wipes
Surgical setup
- operating table: supine position, elevate head if needed to reduce bleeding
- surgical loupes if needed
- bipolar cautery/disposable cautery
- instruments: chalazion clamp, curette, Westcott scissors, fine toothed forceps for skin suture, Castroviejo needle holder
Disposables
- Hibidil® disinfecting solution
- ice-cold NaCl solution
- anaesthetic solution (7.2 ml Rapidocain® 2% with epinephrine + 0.9 ml sodium bicarbonate 8.4% + 0.9 ml tranexamic acid) in 1x 5 ml syringe with a 30G needle
- sterile drape, marking pen, no.15 or no. 11 scalpel blade, gloves
- dental rolls for haemostasis, compresses for haemostasis, eye pad
Sutures (if needed)
- 6-0 Prolene® or 7-0 Vicryl® for skin closure
Surgical technique
Skin disinfection. Cover with a drape exposing the ipsilateral eye. Skin marking with pen. Local anaesthesia.
Transconjunctival approach: evert the eyelid over the chalazion clamp. Vertical incision with a no. 11 scalpel blade. Curettage. Excise capsule if needed.
Transcutaneous approach: place the chalazion clamp. Horizontal skin incision with a no. 15 scalpel blade. Curettage. Excise capsule with scissors if needed. Skin closure with 6-0 Prolene® or 7-0 Vicryl®.
Tobradex® ointment. Eye pad.
Postoperative
- elevate head, reduce physical activity
- leave eye pad on until the following day
- Paracetamol 1g every 6-8 hours if needed (max 4g/day)
Follow-up
- 1 day postop: check visual acuity and bleeding; start Tobradex® ointment 3 times a day
- 7 days postop: suture removal
