Keywords

Indications

Symptomatic conjunctivochalasis explained by tear meniscus dysfunction or the mechanical action of redundant conjunctiva

Essential Steps

  1. 1.

    Topical anesthetic (if needed—subconjunctival or retrobulbar anesthesia)

  2. 2.

    Marking of crescent tissue to be excised

  3. 3.

    Semilunar-shaped incision of conjunctiva

  4. 4.

    Dissection of conjunctiva from Tenon’s capsule

  5. 5.

    Removal of crescent-shaped conjunctiva

  6. 6.

    Hemostasis

  7. 7.

    Suturing or gluing of the conjunctival wound

Complications

  • Giant papillary conjunctivitis

  • Subconjunctival hemorrhage

  • Recurrence of the conjunctivochalasis

  • Procedure failure

  • Conjunctival dehiscence

  • Infection or abscess formation

  • Restriction of gaze

Template Operative Dictation

Preoperative diagnosis:

Conjunctivochalasis (OD/OS)

Procedure:

Repair of conjunctivochalasis (OD/OS)

Postoperative diagnosis:

Same

Indication:

This is a ____-year-old male/female presenting with (a Meller and Tseng grade 1–4 [1]) conjunctivochalasis for ___ (months/years) duration. Despite aggressive medical treatment, the patient’s symptoms did not resolve, and surgical options were discussed. After a detailed review of risks, benefits, and alternatives, the patient elected to undergo the procedure.

Description of the procedure:

The patient was identified in the holding area, and the (right/left) eye was marked with a marking pen. The patient was brought into the operating room and placed on the operating table in the supine position. After a proper time-out was performed verifying correct patient, procedure, site, positioning, and special equipment prior to starting the case, the (right/left) eye was prepped and draped in the usual sterile fashion. The operating microscope was centered over the (right/left) eye and an eyelid speculum was placed. Several drops of topical Tetracaine were instilled into the (right/left) eye.

If subconjunctival injection was performed – (2 or 4) % lidocaine was injected in a subconjunctival fashion.

If retro- or peribulbar injection was performed – A (retro/peri) bulbar injection of 50/50 mix of (2 or 4) % lidocaine and 0.75% bupivacaine was given (with/without) hyaluronidase.

The exact area of conjunctiva to be excised was identified inferiorly, extending ___degrees, from the __ to __ o’clock position. A (marking pen/handheld cautery) was used to outline the area to be excised. A semilunar-shaped area of conjunctiva was incised then dissected off Tenon’s using a Westcott scissors. Special care was taken to ensure that no underlying structures were removed with conjunctiva. Hemostasis was achieved with electrocautery.

[Choose one]:

If the conjunctiva was primarily reapproximated – A total of # interrupted 8-0 Vicryl sutures were used to close the conjunctival wound. The eyelid speculum and drape were removed. Antibiotic ointment was instilled in the inferior fornix, and a shield was placed over the eye. The patient was transferred to the post-anesthesia care unit in stable condition.

If amniotic membrane used – The size of the defect was measured to approximately ___ × ___mm, and an amniotic membrane graft was trimmed to ___ × ___mm. The graft was then glued/sutured to the area of the conjunctival defect with fibrin tissue glue/a total of # interrupted 8-0 Vicryl sutures. The eyelid speculum and drape were removed. Antibiotic ointment was instilled in the inferior fornix, and a shield was placed over the eye. The patient was transferred to the post anesthesia care unit in stable condition.

Additional Resource

http://eyetu.be/jofele.