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Ameet Goyal, Shivani L Goyal, Riya Goyal; A new coagulation treatment paradigm for patients having eyelid surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3113.
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Bleeding during eyelid surgery can present several problems. While placing the local anesthetic, diffuse lid swelling can cause the tissue plains to be irregular. Hematoma formation can cause problems with proper placement of the levator muscle during ptosis procedures. Retro-bulbar bleeding cause blindness. The purpose of this study was to look at different approach to coagulation which involves oral agents as well as topical agents.
All patients who underwent eyelid surgery were recommended to use Arnica montana orally. They were also advised to stop the aspirin at least on week prior to surgery, of their was no medical contraindication. Arnica was started three days before the procedure and continued for 1 week post surgery. During the procedure, gel foam soaked in thrombin was placed in the wound. Crushed ice was poured in a sterile glove and then placed over the wound. The ice was placed after the gel foam and thrombin was removed. This procedure was performed in all patients that had eyelid surgery for ptosis repair, upper and lower lid blepharoplasty, ectropion, entropion, basal cell with reconstruction, and all anterior orbital procedures. The level of eyelid edema was scored based on the amount of erythema, swelling, and any evidence of hematoma formation.
This study looked at a retrospective review of five hundred patients over a 10 year period in one multi-specialty practice. The level of swelling was then observed in a clinical setting or based on post-operative photos by one surgeon. This was measured from a level of one to five. The operative reports for all these patients were were also analyzed. The patients who received no gel foam soaked thrombin and no ice during the procedure had significantly higher levels of swelling than those age matched cohorts which received gel-foam soaked thrombin and ice. The patients who only had ice or thrombin during their procedure were analyzed as well. This group still had significant amount of swelling compared to the patients who received both during their surgery. The patients who did follow the treatment protocol had no adverse sequela.
This study reveals a new treatment paradigm for patient who are undergoing eyelid surgery. This is based on a twenty year experience in eyelid surgery. This new paradigm may help to eliminate some of the complications associated with eyelid swelling post surgery.
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