Name of the Procedure

Common Name(s): Dexamethasone Lacrimal Insert
Technical/Medical Term: Dexamethasone, lacrimal ophthalmic insert, 0.1 mg (HCPCS Code: J1096)

Summary

Dexamethasone lacrimal ophthalmic insert is a tiny device placed into the lower eyelid. It slowly releases dexamethasone, a corticosteroid, to help reduce inflammation and discomfort in the eye.

Purpose

Medical Conditions Addressed:

• Dry eye syndrome
• Postoperative inflammation

• Ocular surface disease

  Goals/Outcomes:

• Reduce inflammation and swelling in the eye.
• Provide relief from symptoms such as dryness, burning, and redness.
• Promote healing after ocular surgery or injury.

Indications

Symptoms/Conditions:

• Persistent dry eyes not relieved by regular eye drops.
• Significant inflammation post eye surgery.
• Chronic ocular surface inflammation.

Patient Criteria:

• Patients with contraindications to oral or topical steroid therapy.
• Those who have not responded well to other treatments.

Preparation

Pre-Procedure Instructions:

• No specific fasting required.
• Avoid using other eye drops on the day of the procedure unless advised by the doctor.

Diagnostic Tests:

• Comprehensive eye exam.
• Evaluation of ocular surface and tear production.

Procedure Description

Step-by-Step Process:

1. The patient is positioned comfortably in a reclined chair.
2. A small rod-like device with the dexamethasone insert is prepared.
3. The lower eyelid is gently pulled down.
4. The dexamethasone insert is placed into the lower conjunctival sac.
5. The insert remains in place, slowly releasing medication over time.

Tools and Equipment:

• Dexamethasone insert
• Placement rod

Anesthesia:

• Usually, no anesthesia is required. Minor discomfort may be managed with local numbing drops.

Duration

The placement procedure generally takes about 5-10 minutes.

Setting

Typically, this procedure is performed in an outpatient clinic or an ophthalmologist's office.

Personnel

Healthcare Professionals Involved:

• Ophthalmologist or optometrist
• Medical assistant or nurse

Risks and Complications

Common Risks:

• Mild discomfort or irritation
• Foreign body sensation in the eye

Rare Complications:

• Infection
• Allergic reaction to dexamethasone

Management of complications typically involves removal of the insert and additional treatments as necessary.

Benefits

Expected Benefits:

• Significant reduction in ocular inflammation
• Relief from dry eye symptoms
• Improved ocular surface healing

Realization of Benefits:

• Benefits can often be felt within a few days to a week.

Recovery

Post-Procedure Care:

• Patients should avoid rubbing their eyes.
• Continue regular eye care routine as advised.
• Schedule follow-up appointments to monitor progress.

Recovery Time:

• Most patients resume normal activities immediately.
• Complete recovery of symptoms may take several weeks.

Alternatives

Other Treatment Options:

• Oral or topical corticosteroids
• Artificial tears or lubricating eye drops
• Punctal plugs

Pros and Cons of Alternatives:

• Oral/topical steroids: Effective but may cause systemic side effects.
• Artificial tears: Safe but may not provide sufficient relief for severe cases.
• Punctal plugs: Effective in retaining moisture but less effective in reducing inflammation.

Patient Experience

During the Procedure:

• Mild pressure or discomfort when the insert is placed.
• Occasionally, foreign body sensation which usually subsides.

After the Procedure:

• General discomfort should subside within a few hours.

• Patients may need to follow up if they experience unusual pain, redness, or swelling.

  Pain Management:

• Over-the-counter pain relievers if needed.
• Cold compresses to alleviate initial discomfort.