DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Involutional entropion, right lower eyelid.
POSTOPERATIVE DIAGNOSIS: Involutional entropion, right lower eyelid.
OPERATION PERFORMED: Entropion repair of right lower eyelid.
SURGEON: John Doe, MD
ANESTHESIA: Local infiltrative, topical ocular, with monitored anesthesia care.
ESTIMATED BLOOD LOSS: 15 mL.
DESCRIPTION OF OPERATION: After informed consent was obtained, the patient was taken to the operating room and placed supine on the operating room table. Previously, an alcohol pad had been used to defat the skin of the right lower lid as well as the right lateral canthus. After this, a gentian violet marking pen had been used to mark the right lateral palpebral raphe. The patient received appropriate preoperative monitoring and sedation and a solution of 2% lidocaine with 1:200,000 parts epinephrine was instilled subcutaneously along the length and breadth of the right lower lid and the right lateral canthus. In addition, an infraorbital nerve block was performed by delivering the same solution in the area of the infraorbital foramen. The anesthetic agent was massaged into place. The surgeon performed a surgical scrub. The patient was prepped and draped in the usual sterile fashion for ophthalmic surgery. A hard corneoscleral shield was placed before the cornea of the right eye after a series of 0.5% topical tetracaine drops had been applied.
A double armed 4-0 chromic suture was then passed through the white band of the lower lid retractors transconjunctivally to exit in an infraciliary position, rotating the right lower lid outward and reattaching the right lower lid retractors. A series of three of these double armed 4-0 chromic sutures were thus passed. The right lower lid was everted into the correct position. Attention was directed to the right lateral canthus. A #15 Bard Parker blade was used to incise the previously demarcated gentian violet line. A sharp Westcott scissor was used to fashion a lateral canthotomy and cantholysis. The inferior crus of the lateral canthal tendon was released from its attachment using Ellman radiofrequency unit dissection. The right lower lid was noted to swing freely. The orbicularis oculi muscle was also released in a posterior orbicularis fascial plane. A right lateral tarsal strip was fashioned by resecting a full thickness portion of the right lower lid at the appropriate amount of right lower lid tightening, which was previously measured by the overlapping technique, estimating the amount of excess eyelid to form good apposition and no lower lid lag at the lateral canthal angle.
The right lower lid was noted to be in appropriate contour and position when compared to the left lower lid. The lateral tarsal strip was then anastomosed to the orbital tubercle 5 mm posterior to the anterior face of the lateral orbital rim utilizing a 4-0 double armed Prolene suture in a horizontal mattress fashion. The lid level and contour was again noted to be appropriate and the lid margin was repaired in a standard three-lid margin technique, anastomosing just anterior to the mucocutaneous junction, the lash line and the gray line. The ends of the previous suture were left long and incorporated into the subsequent one to prevent corneal irritation. The lateral palpebral raphe was repaired with a series of interrupted 6-0 fast absorbing plain suture. The hard corneoscleral shield had been removed after a series of 0.5% topical tetracaine drops had been applied. The patient tolerated the procedure well. The eye was dressed with Maxitrol ointment and the patient was taken to the recovery room in stable condition.
