Name of the Procedure:

Excision of lesion, conjunctiva; with adjacent sclera

Common Name(s): Conjunctival lesion removal, Conjunctival excision with scleral involvement

Summary

This procedure involves the surgical removal of a lesion from the conjunctiva, which is the membrane that covers the front of the eye and the inside of the eyelids. It also includes the removal of a small part of the adjacent sclera, the white part of the eye.

Purpose

The purpose of this procedure is to remove abnormal growths, lesions, or tumors on the conjunctiva and the adjacent sclera. The goal is to eliminate the lesion, prevent its spread, and improve eye health and function.

Indications

• Abnormal growths, such as pterygium, pinguecula, or cysts.
• Suspected malignant or pre-malignant lesions.
• Persistent irritation or discomfort caused by the lesion.
• Visual disturbances due to the presence of the lesion.

Preparation

• Patients may be advised to stop certain medications, such as blood thinners, before the procedure.
• Fasting might be required for a few hours if general anesthesia is planned.
• Pre-procedure assessments may include a thorough eye examination and imaging tests.

Procedure Description

1. The patient is positioned comfortably, and local or general anesthesia is administered.
2. The eye and surrounding area are sterilized.
3. The surgeon uses fine surgical instruments to carefully excise (cut out) the lesion along with a margin of the adjacent conjunctiva and sclera.
4. The area is then typically closed with fine sutures or may be left to heal on its own, depending on the case.
5. An antibiotic ointment and a protective eye patch may be applied to prevent infection and promote healing.

Duration

The procedure typically takes around 30 to 60 minutes, depending on the size and complexity of the lesion.

Setting

The procedure is usually performed in an outpatient surgical center or hospital.

Personnel

• Ophthalmic surgeon
• Surgical nurse
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Scar formation
• Recurrence of the lesion
• Scleral thinning or perforation
• Vision changes or impairment

Benefits

• Removal of the lesion
• Relief from symptoms such as irritation or discomfort
• Prevention of potential malignancy spread
• Improved vision if the lesion was obstructing sight

Recovery

• Patients might go home the same day.
• Follow post-operative care instructions, including using prescribed eye drops or ointments.
• Avoid rubbing or putting pressure on the eye.
• Attend follow-up appointments to monitor healing.
• Avoid strenuous activities until cleared by the surgeon.
• Recovery time can vary but typically ranges from a few days to a couple of weeks.

Alternatives

• Observation, especially if the lesion is benign and asymptomatic.
• Non-surgical treatments like topical medications.
• Cryotherapy (freezing the lesion)
• Laser therapy

The pros and cons of each alternative would be individualized based on the lesion type, location, and patient-specific factors.

Patient Experience

During the procedure, patients under local anesthesia may feel mild pressure or discomfort, but not pain. Those under general anesthesia will be asleep and unaware. Post-procedure, there might be mild to moderate eye pain and discomfort, managed with prescribed pain medications. Sensitivity to light and temporary vision changes may also occur.