Name of the Procedure:

Excision of Lesion, Sclera
Common name(s): Scleral lesion removal

Summary

Excision of a lesion on the sclera involves surgically removing an abnormal growth or tissue from the white part of the eye, known as the sclera. This procedure is typically performed to alleviate symptoms, prevent further complications, or confirm a diagnosis through pathological examination.

Purpose

The procedure addresses abnormal growths, infections, or inflammations on the sclera. The goals include:

• Relieving discomfort or pain caused by the lesion
• Preventing progression of the lesion that might impair vision or affect surrounding structures
• Analyzing the removed tissue to detect or rule out malignancy

Indications

• Persistent or painful lesions on the sclera
• Suspicion of malignancy or infection
• Cosmetic concerns due to visible lesions
• Lesions affecting vision or eye movement

Preparation

• Patients may need to fast for several hours before the procedure if general anesthesia is planned.
• Adjustments to current medications, especially blood thinners.
• Comprehensive eye examination and imaging studies like ultrasound biomicroscopy or MRI to assess the lesion.

Procedure Description

1. Anesthesia: Local anesthesia with or without sedation, or general anesthesia, depending on the lesion’s size and location.
2. Incision: A small incision is made in the conjunctiva, the clear tissue covering the sclera.
3. Excision: The lesion is carefully excised using microsurgical instruments. In some cases, adjunctive tools like a surgical microscope or lasers may be employed.
4. Closure: The site is sutured or, sometimes, left to heal on its own. Antibiotic and anti-inflammatory medications are applied.
5. Post-procedure: An eye patch or bandage might be placed over the eye.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the lesion’s complexity.

Setting

The procedure can be performed in an outpatient surgical center or a hospital.

Personnel

• Ophthalmic Surgeon
• Surgical Nurse
• Anesthesiologist (if general anesthesia is used)
• Ophthalmic Technician

Risks and Complications

• Common risks: Infection, bleeding, and temporary vision disturbances.
• Rare risks: Perforation of the sclera, recurrence of the lesion, and adverse reaction to anesthesia.

Benefits

• Relief from symptoms such as pain or irritation.
• Prevention of potential vision impairment or other complications.
• Peace of mind through biopsy results, especially in ruling out malignancy.
• Cosmetic improvement if the lesion is visibly prominent.

Recovery

• Post-procedure care includes using prescribed antibiotic and anti-inflammatory eyedrops.
• Avoiding strenuous activities and eye movements for a few days.
• Wearing an eye patch or protective eyewear as advised.
• Recovery time generally ranges from a few days to a week.
• Follow-up appointments to monitor healing and any signs of complications.

Alternatives

• Observation: Regular monitoring if the lesion is benign and asymptomatic.
• Cryotherapy: Freezing the lesion in certain cases.
• Laser therapy: Non-invasive but may not be suitable for all lesion types.
• Pros and cons: Less invasive alternatives may have lower risk but also potentially lower efficacy in completely removing or diagnosing the lesion.

Patient Experience

• During: Minimal discomfort due to anesthesia. If awake, you may feel slight pressure.
• After: Mild discomfort or irritation, which can be managed with prescribed pain relievers and anti-inflammatory medications.
• Follow strict aftercare guidelines to ensure proper healing and minimize risks.

Each patient’s experience may vary, and it is important to discuss any concerns with the healthcare provider beforehand.