Conjunctival Cautery

This is richardAllen@ocularsurge.com. This video demonstrates the use of high temperature thermal cautery in the treatment of conjunctival chalais. This patient is to have a lateral tarsal strip performed as well, which is often done concurrently in my patients with conjunctival chalais. A sub conjunctival injection of lidocaine with epinephrine has been given and topical anesthesia has been applied. The thermal cautery is then applied to the surface of the conjunctiva in the area of the conjunctival chalais. The area of redundant conjunctiva has been identified preoperatively and is a diffusely addressed with the thermal cautery. This results in a superficial injury of the conjunctiva, which will contract with tissue healing and reepithelialization. It is important to only apply the cautery superficially to the conjunctiva.

I've used a number of different approaches in addressing conjunctival chalais. I've resected the redundant conjunctiva and suture the defect closed. I've also lifted the redundant conjunctiva with forceps and cauterized the redundant conjunctiva in the forceps. The more focal treatment with those techniques seems to give me a focal area of scar, which was sometimes bothersome to the patient. The cautery is applied only to the bulbar conjunctiva and can extend to the fornix. This is usually a bilateral process in the other eye, which did not have as much redundant conjunctiva is then addressed. The diffuse cauterization seems to be less prone to focal areas of irritation after the surgery. As this site is not as significant, less cautery will be applied at the borders of the treatment area. The application is feathered out. The patient will apply antibiotic ointment to the area three times per day for a week. They will follow up in approximately two weeks for reevaluation. The two photos at the end of the video show the areas two weeks after surgery. In general, patients will have some irritation after the surgery, but this is usually addressed well with the antibiotic ointment.