Repair of entropion; thermocauterization
CPT4 code
Name of the Procedure:
Repair of Entropion; Thermocauterization
Summary
The repair of entropion using thermocauterization is a procedure aimed at correcting a condition where the eyelid turns inward, causing the eyelashes to rub against the eye. This procedure involves using heat to tighten the eyelid tendons, thereby positioning the eyelid correctly.
Purpose
Medical Condition:
Entropion is a condition where the eyelid turns inward, leading to irritation, discomfort, and potential damage to the cornea due to the eyelashes rubbing against the eye.
Goals:
The main objectives are to alleviate discomfort, prevent corneal damage, and restore normal eyelid function by tightening the eyelid tendons with thermocauterization.
Indications
- Persistent eye irritation and redness
- Eyelash rubbing against the cornea (trichiasis)
- Frequent eye infections or inflammation
- Corneal abrasions or ulcers due to eyelid position
- Patient has not responded to less invasive treatments like lubricating eye drops or ointments
Preparation
- Patients may be advised to stop certain medications such as blood thinners a few days before the procedure.
- Fasting is generally not required unless sedation or general anesthesia is used.
- A pre-procedure assessment, including a detailed eye examination and sometimes imaging tests, is performed to confirm the diagnosis and plan the treatment approach.
Procedure Description
- Anesthesia: Local anesthesia is typically administered to numb the eyelid area.
- Thermocauterization: A specialized instrument is used to apply controlled heat to the muscles and tendons of the eyelid.
- Tightening: The thermal energy tightens and stiffens the affected tissues, correcting the inward turning of the eyelid.
- Completion: The procedure is usually done in a single session, although follow-ups may be scheduled to ensure proper healing.
Tools:
- Thermocautery device
- Local anesthesia
Duration
The entire procedure typically takes about 30 to 60 minutes.
Setting
The procedure is usually performed in an outpatient clinic or an ophthalmology surgical center.
Personnel
- Ophthalmic surgeon or oculoplastic specialist
- Assisting nurses and possibly an anesthetist if sedation is required
Risks and Complications
- Infection
- Excessive bleeding
- Scarring
- Recurrence of entropion
- Burns or excessive tissue damage
- Adverse reactions to anesthesia
Benefits
- Immediate relief from irritation and discomfort
- Protection of the cornea from damage
- Improved vision if it is affected by the condition
- Most patients experience significant improvement shortly after the procedure
Recovery
- Patients may experience mild discomfort, swelling, and redness in the treated area.
- Use of prescribed antibiotic ointments or drops to prevent infection and aid healing.
- Avoid rubbing the eyes and strenuous activities for a few days.
- An eye patch may be recommended for the first 24 hours.
- Follow-up visits to monitor healing and function are typically scheduled within a week after the procedure.
Alternatives
- Conservative treatments like lubricating eye drops and ointments.
- Surgical options such as full-thickness eyelid surgery for more severe cases.
- Botox injections to temporarily paralyze the muscles pulling the eyelid inward (less common).
Pros and Cons:
- Conservative Treatments: Less invasive but often temporary and not always effective.
- Surgical Options: More definitive but involve longer recovery times and higher risks of complications.
Patient Experience
During:
- Minimal discomfort due to local anesthesia.
- Patients will be awake and may feel slight pressure or warmth.
After:
- Mild pain, swelling, and redness managed with over-the-counter pain relievers.
- Most discomfort subsides within a few days.
- Patients are usually allowed to return to normal activities within a week, with specific care instructions to ensure proper healing.