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Correction of everted punctum, cautery
CPT4 code
Name of the Procedure:
Correction of Everted Punctum, Cautery
(Also known as Punctal Cautery)
Summary
This procedure involves using cautery (a heat-based tool) to correct an everted punctum, a condition where the tear duct opening is turned outward, leading to tear drainage issues.
Purpose
The purpose of this procedure is to treat an everted punctum which can cause excessive tearing (epiphora) due to improper drainage. The goal is to reposition the punctum to facilitate normal tear drainage and resolve the symptoms of tearing.
Indications
- Persistent tearing (epiphora)
- Discomfort or irritation from misdirected tears
- Frequent eye infections due to improper tear drainage
- Previously tried non-surgical treatments without success
Preparation
- Patients may be advised to stop certain medications (like blood thinners) before the procedure.
- Eye examination and tear duct assessment are typically conducted.
- Fasting is generally not required.
- Patients should arrange for transportation if sedation is being used.
Procedure Description
- Anesthesia: Local anesthesia is applied to numb the area around the punctum.
- Cauterization: The surgeon uses a cautery device to apply heat to the tissue around the everted punctum.
- Repositioning and Healing: The heat helps to reshape and reposition the punctum so it can drain tears properly.
- Post-Procedural Care: Antibiotic eye drops or ointment may be applied to prevent infection.
Duration
The procedure typically takes about 15-30 minutes.
Setting
The procedure is usually performed in an outpatient clinic or an eye doctor's office.
Personnel
- An ophthalmologist or oculoplastic surgeon
- Ophthalmic nurse or assistant
Risks and Complications
- Infection at the site of the procedure
- Scarring or over-correction causing stenosis (narrowing) of the tear duct
- Temporary discomfort or irritation
- Rare cases of punctal stenosis requiring further intervention
Benefits
- Improved tear drainage
- Reduction or elimination of excessive tearing
- Relief from associated discomfort and risk of eye infections
- Benefits are usually realized within a few days post-procedure
Recovery
- Patients may experience minor discomfort or redness for a few days.
- Use prescribed antibiotics or anti-inflammatory eye drops as directed.
- Avoid rubbing the eyes and follow up with the surgeon as advised.
- Most patients can resume normal activities within a couple of days.
Alternatives
- Conservative Management: Use of lubricating eye drops or ointments.
- Punctal Plugs: Temporary plugs inserted into the punctum to aid drainage.
- Surgical Intervention: Procedures like punctoplasty if cautery is not suitable.
Patient Experience
- During the procedure, patients might feel slight pressure but should not feel pain due to local anesthesia.
- Post-procedure, there might be mild discomfort, managed with over-the-counter pain relievers.
- Patients usually experience significant relief from tearing and irritation within a few days.