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February 2012

What Is This Month's Mystery Condition?
Written by James A. Wrzosek, MD, and Amy M. Fowler, MD, University of North Carolina at Chapel Hill. Edited by Michael P. Kelly, FOPS.

Photo by Rona Lyn Esquejo-Leon, CRA, Univer­sity of North Carolina at Chapel Hill
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February 2012 Blink

Thermal Cautery for Conjunctival Chemosis and Conjunctivochalasis

A 56-year-old woman presented with a gel-like growth in the right eye that had appeared two months earlier. She had used over-the-counter allergy drops and Visine (tetrahydro­zoline hydrochloride), neither of which helped. Examination of the right eye showed a prominent area of nasal conjunctival chemosis and conjunctivochalasis without redness. There was no overlying breakdown of the conjunctiva, no abnormal pigmentation and no telangiectatic or other sentinel vessels in this area. Over time, the swelling became progressively larger and more irritating.

We recommended that the patient undergo conjunctivoplasty with high-temperature cautery to shrink the chemosis and con­junctivochalasis. The patient received topical and subconjunctival anesthesia, and the lesion was spot treated with high-temperature cautery. Thirty application spots were placed in the area of the conjunctival chemosis. The cautery was activated to full tempera­ture, the trigger was released and the metal tip was then placed directly on the conjunctiva—which contracted upon contact.

At the first postop visit two days after the procedure, the patient complained of eye redness and discomfort. On examina­tion, vision in the treated eye was 20/20, and the conjunctiva appeared to be healing well. She was started on Lotemax (loteprednol) four times a day. Two weeks after surgery, the patient had no com­plaints. She reported no pain and believed that the eye had healed well. On examination, vision was 20/20, and the conjunctiva had healed well with no residual erythema or chemosis. All medications were stopped at this time. As of seven months after the procedure, the patient had not had a recurrence.


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