Cryotherapy for eyelash follicle destruction
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This is Richard Allen at the University of Iowa. This video demonstrates the use of cryotherapy for the destruction of eyelashes. The patient has a history of a medial and lateral tarsorrhaphy for exposure keratopathy. The patient developed an area of distichiasis post-operatively. The area has been anesthetized with lidocaine with epinephrine. The cryo probe is placed in the area of the aberrant lashes and freezing is attained. The probe will reach a temperature of -80 degrees Fahrenheit. In the destruction of lashes of the lower lid, a freezing should be performed for 25 seconds. This is then allowed to thaw and then the probe is placed along the area next to it. For the upper eyelid, the lashes are a bit more resistant to cryo therapy and a freezing of approximately 35 seconds is performed. In order to attain destruction of the lash follicles, a double freeze-thaw is performed. After complete thawing, the cryo probe is again placed in the area medially. You will notice on the second freezing cycle that the ice ball appears more quickly. Again, this is performed for 25 seconds and then the area is allowed to completely thaw. The probe is then move adjacent with a slight overlap and an additional freeze-thaw is performed. You need to be aware that there is significant swelling and pain after cryo therapy to the eyelid. Also, hypopigmentation can occur, and the procedure should probably not be performed in patients with significant pigment. Epilation of the lashes is then performed in this case with a needle holder. Ideally the lashes slide out with minimal resistance. At the conclusion of the cases all lashes have been removed.