Destruction of Prominent Superficial Eyelid Veins

Prominent superficial eyelid veins can be difficult to treat.  They are usually too big for any laser procedures and incisional procedures can leave an unsatisfactory scar.  I have found that the use of an angiocath with a monopolar cautery can be useful in addressing these veins.  The angiocath allows the current to travel to the tip of the needle, while the catheter acts as an insulator and does not burn the skin. 

This is Richard Allen at oculosurg.com.  This video demonstrates destruction of prominent, superficial eyelid veins using an angiocath and electrocautery.  The prominent superficial vein is noted inferior to the brow.  The lid crease was marked for an additional procedure.  A 24-gauge angiocath is inspected.  The insulation adjacent to the hub is then removed with a 15 blade.  This allows the insulation to remain intact along the remainder of the needle until the tip.  The angiocath is then inserted into the prominent superficial vein.  The exposed metal of the needle is then placed in contact with the monopolar cautery.  The insulation of the angiocath protects the skin from getting burned from the cautery.  I usually start very low with the cautery on 2 watts and slowly increase it until I get a disruption of the blood vessel.  As is noted, there is no burn at the entry site in the skin.  The angiocath can then be reinserted at additional areas of the vein.  If possible, the cannula is actually place intravascularly.  A hematoma has developed in one of the areas of vessel disruption.  Usually, multiple entry sites need to be used, but I have found this to be a useful procedure that leaves no scars on the skin, and angiocaths are readily available.