By David T. Tse MD
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Extra resources for Color Atlas of Oculoplastic Surgery
The speciﬁc anesthetic agents to be used are best determined by the preference of the anesthesiologist. When the patient becomes cognizant of his surroundings, the procedure is well underway, and cooperation may be elicited from the patient to monitor eyelid position. With the proper utilization of pharmacologic agents, patients experience little discomfort intraoperatively or postoperatively. Indications for general anesthesia are diminishing with the improvement of neuroleptic anesthesia. General anesthesia is usually reserved for those patients undergoing more invasive procedures, such as orbital procedures, or in whom cooperation is difﬁcult, such as children.
Care should b e e xe rcise d whe n re moving lowe r e ye lid tumors, b e cause e xce ssive skin e xcision with a horizontally orie nte d e llip se may p rod uce a p ostop e rative e ctrop ion. If a q ue stion e xists ab out a horizontally orie nte d lowe r lid e xcisional b iop sy, it should b e rotate d ve rtically to p re ve nt the d e ve lop me nt of p ostop e rative e ctrop ion. Full-thickness eyelid biopsies should be considered in patients with chronic blepharoconjunctivitis or recurrent chalazion suspected of having a sebaceous gland carcinoma.
CHAPTER 2 FUNDAMENTAL TECHNIQUES IN OPHTHALMIC PLASTIC SURGERY Fig ure 2-2. Putte rman (1986) has d e scrib e d a me thod of conjunctival b iop sy and map p ing to d e te rmine the p re se nce and e xte nt of p ag e toid sp re ad of the e p ithe lium associate d with se b ace ous g land carcinoma. This is ne ce ssary b e cause p ag e toid sp re ad may involve are as of conjunctiva that ap p e ar normal. Up p e r and lowe r e ye lid s are e ve rte d ove r De smarre s re tractors. Conjunctival b iop sie s are take n from the sup e rior and infe rior te mp oral, ce ntral, and nasal p alp e b ral conjunctiva.