Repair of ectropion; excision tarsal wedge

CPT4 code

Name of the Procedure:

Repair of ectropion; excision tarsal wedge
Common Name: Ectropion Repair

Summary

Repair of ectropion with excision tarsal wedge is a surgical procedure to correct the outward turning of the eyelid, usually the lower one. This condition exposes the inner eyelid and can lead to irritation, tearing, and potential damage to the eye.

Purpose

This procedure addresses the condition known as ectropion, where the eyelid turns outward. The goals are to reposition the eyelid to its normal position, protect the eye surface, prevent any further damage, and alleviate symptoms such as irritation and excessive tearing.

Indications

Chronic redness and irritation of the eye caused by ectropion.
Excessive tearing.
Eye dryness.
Recurrent eye infections or inflammation.
Tired or painful eyelids.
Visible outward turning of the eyelid.

Preparation

Patients may need to fast for a certain period before the procedure.
Adjustments to current medications may be required (e.g., blood thinners).
An eye examination and possibly tests to assess tear production or measure the eyelid position.

Procedure Description

Anesthesia: Local anesthesia with sedation is usually administered.
Incision: A small incision is made on the affected eyelid.
Excision: A wedge-shaped section of the tarsal plate (the firm structure within the eyelid) is excised.
Realignment: The edges of the eyelid are then stitched together to tighten and reposition the eyelid properly.
Closure: The incision is closed with sutures that may be absorbable or require removal later.

Duration

The procedure typically takes about 30-60 minutes.

Setting

Performed in an outpatient surgical center or a hospital.

Personnel

Ophthalmic surgeon.
Nursing staff.
Anesthesiologist or sedation nurse.

Risks and Complications

Infection.
Bleeding.
Scarring.
Asymmetry of the eyelids.
Temporary or permanent changes in eyelid sensation.
Persistent tearing or dryness.
Need for additional surgery if results are unsatisfactory.

Benefits

Relief from irritation and redness.
Improved appearance of the eyelid.
Enhanced ocular surface protection.
Reduced risk of eye infections and inflammation.
Immediate improvement in tearing, though full benefits may be observed within a few weeks.

Recovery

Application of prescribed ointments or eye drops to aid healing.
Use of cold compresses to reduce swelling.
Avoiding strenuous activities and not rubbing the eyes.
Keeping the head elevated while sleeping to reduce swelling.
Follow-up appointments to monitor healing and remove stitches if necessary.
Recovery typically ranges from 1-2 weeks for initial healing, with full recovery in a few months.

Alternatives

Non-surgical treatments like artificial tears or lubricating ointments.
Using specialized contact lenses to protect the eye surface.
Other surgical procedures, such as skin grafting or muscle tightening.
Each alternative has its pros and cons to consider based on the severity of ectropion and patient-specific factors.

Patient Experience

Mild discomfort or pain during and after the procedure, managed with prescribed pain relievers.
Swelling and bruising around the surgical site that diminishes over a week.
Temporary blurry vision due to ointment use.
Detailed post-operative care instructions to enhance comfort and ensure proper healing.