65815 Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection

Name of the Procedure:

Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection

Summary

Paracentesis of the anterior chamber of the eye is a minor surgical procedure in which a small incision is made in the front (anterior chamber) of the eye to remove accumulated blood. This may be done with or without the use of irrigation (flushing with a sterile fluid) and/or air injection to ensure the complete removal of blood and to stabilize eye pressure.

Purpose

This procedure is performed to alleviate elevated intraocular pressure caused by the presence of blood in the anterior chamber, which can occur due to trauma, surgery, or certain eye conditions. The main goals are to restore normal eye pressure, improve vision, and prevent further complications such as damage to the optic nerve or cornea.

Indications

• Presence of blood in the anterior chamber (hyphema)
• Elevated intraocular pressure unresponsive to medication
• Vision impairment due to accumulated blood
• Risk of corneal blood staining or angle recession caused by the hyphema
• Patient characteristics making conservative management unsuitable

Preparation

• Patients may be required to fast several hours before the procedure.
• Anti-coagulant or blood-thinning medications may need to be adjusted as directed by the physician.
• Pre-procedure assessments could include vision tests, intraocular pressure measurement, slit-lamp examination, and possibly imaging studies such as an ultrasound of the eye.

Procedure Description

1. The patient receives a local anesthetic drop to numb the eye.
2. The eye area is cleansed with a sterile solution.
3. A small, precise incision is made in the cornea to access the anterior chamber.
4. Blood is gently removed via suction or by flushing the anterior chamber with a sterile solution (irrigation).
5. Air may be injected into the chamber to help stabilize the structure of the eye.
6. The incision is closed, often with a self-sealing technique.
7. An antibiotic and/or steroid drop is administered to reduce the risk of infection and inflammation.

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

This procedure is generally performed in an outpatient setting, such as a hospital ophthalmology department or an eye clinic.

Personnel

• Ophthalmic surgeon
• Nurse or ophthalmic technician
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection
• Increased intraocular pressure post-procedure
• Damage to surrounding eye structures
• Potential need for additional surgical intervention
• Corneal edema or endothelial cell loss
• Rarely, retinal detachment

Benefits

• Rapid alleviation of elevated intraocular pressure
• Improved vision post-procedure
• Prevention of long-term complications from blood in the anterior chamber
• Most patients experience relief within hours to days after the procedure.

Recovery

• Patients are usually sent home the same day with an eye patch or shield.
• Post-procedure care includes using prescribed antibiotic and steroid eye drops.
• Follow-up appointments are scheduled to monitor healing and intraocular pressure.
• Patients should avoid strenuous activities and heavy lifting for a few weeks.

Alternatives

• Medication to lower intraocular pressure (less effective in severe cases)
• Observation with protective eyewear to allow spontaneous resolution
• Laser therapy (limited use in certain conditions)
• Each alternative comes with different risks and benefits, and their suitability depends on the severity of the condition and patient-specific factors.

Patient Experience

• During the procedure, patients may feel mild pressure but should not experience pain due to the local anesthetic.
• Post-procedure discomfort is usually minimal and managed with prescribed pain medication if necessary.
• Some temporary blurriness and light sensitivity can occur but typically resolve as the eye heals.
• Most patients find the procedure tolerable and appreciate the rapid improvement in symptoms.