Excision of lesion, conjunctiva; over 1 cm
CPT4 code
Name of the Procedure:
Excision of Lesion, Conjunctiva; Over 1 cm
Common Names: Conjunctival Lesion Removal, Removal of Conjunctival Growth
Summary
The excision of a conjunctival lesion over 1 cm is a surgical procedure to remove an abnormal growth located on the conjunctiva, the thin, clear tissue covering the white part of the eye and the inside of the eyelids.
Purpose
Medical Condition: This procedure addresses the presence of abnormal tissue, such as benign tumors, cysts, or pre-cancerous lesions on the conjunctiva.
Goals/Expected Outcomes: The primary goal is to remove the lesion completely to prevent potential progression to malignancy, alleviate discomfort, and improve vision if the lesion affects sight.
Indications
Symptoms/Conditions: Patients experiencing visual disturbances, persistent eye irritation, or a noticeable growth on the eye's surface might require this procedure.
Patient Criteria: This procedure is appropriate for patients with lesions larger than 1 cm that are troublesome due to symptoms or have a potential for malignancy.
Preparation
Pre-procedure Instructions:
- Fasting may be required if general anesthesia is used.
Patients should disclose all medications and supplements; adjustments may be needed, particularly with blood thinners.
Diagnostic Tests/Assessments:
- Comprehensive eye examination.
- Imaging studies such as an ultrasound biomicroscopy or anterior segment optical coherence tomography (OCT).
Procedure Description
The surgeon will:
- Administer local anesthesia, or general anesthesia if necessary.
- Use a fine scalpel or surgical scissors to carefully remove the lesion from the conjunctiva.
- Control any bleeding using a cautery tool or other hemostatic methods.
- Stitch the conjunctiva as needed or apply a special tissue adhesive.
- Apply an antibiotic ointment and possibly a protective eye pad.
Tools/Equipment:
- Scalpel, surgical scissors, cautery tool, sutures, tissue adhesive, and antibiotic ointment.
Duration
The procedure typically takes about 30 to 60 minutes, depending on the lesion's size and complexity.
Setting
This procedure is usually performed in an outpatient setting such as an eye clinic or surgical center.
Personnel
The procedure involves an ophthalmic surgeon, surgical nurse, and an anesthesiologist if general anesthesia is administered.
Risks and Complications
Common Risks: Minor bleeding, infection, and temporary blurred vision.
Rare Risks: Permanent scarring, recurrence of the lesion, significant bleeding, and impact on adjacent eye structures.
Management of Complications: Infections can be treated with antibiotics, and considerable bleeding might require further surgical intervention.
Benefits
Expected Benefits: Complete removal of the lesion, relief from symptoms, prevention of malignant transformation, and potential improvement in vision.
Realization Timeline: Most benefits are seen immediately, with continued healing over several weeks.
Recovery
Post-procedure Care:
- Apply prescribed eye drops or ointment.
- Avoid rubbing or touching the eye.
- Follow up with the surgeon for removal of stitches (if used) and monitoring.
Restrictions: Limit activities that may strain the eyes or introduce contaminants, such as swimming.
Recovery Time: Typically, full recovery occurs within a few weeks, but individual healing times may vary.
Alternatives
Other Treatments:
- Observation and regular monitoring if the lesion is asymptomatic and benign.
- Laser therapy or cryotherapy.
Pros and Cons of Alternatives: Observation avoids surgical risks but does not address potential growth; laser or cryotherapy may have less invasive approaches but may not be as definitive as surgical excision.
Patient Experience
During the Procedure: Patients under local anesthesia will remain awake but should feel minimal pain due to the numbing medication. General anesthesia will ensure the patient is asleep and comfortable.
After the Procedure: Patients may experience mild discomfort or itching, which can be managed with pain relief medications and cold compresses. Instructions will be provided for eye care to ensure proper healing and comfort.