Resection of prolapsed orbital fat into the subconjunctival space
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This is Richard Allen at the University of Iowa.
This video demonstrates resection of prolapsed orbital fat into the subconjunctival space.
It is important to differentiate this condition from a lipodermoid. Often the patients will have bilateral prolapsed fat. The area is anesthetized with lidocaine with epinephrine. The patient usually tolerates the procedure well with just local anesthesia. Westcott scissors are used to make an incision through the conjunctiva at the medial extent of the lesion. The fat is then encountered and dissection is carried out around the fat to mobilize it. Usually the fat is relatively mobile and not much dissection will need to be carried out. Superiorly, it is important to not dissect too high into the region of the lacrimal gland. This could potentially damage the lacrimal gland ductules and cause a dry eye. After the fat is mobilized, Westcott scissors can be used to resect the prolapsed fat at its base. One could use cautery here to prevent hemorrhage. I consciously do not pull too hard on the fat or cut quickly without checking for hemorrhage. I do not think that you have to chase fat that is posterior. One should also be cognizant of the proximity of the lateral rectus muscle. After hemostasis is assured, the conjunctiva can be closed with superficial, interrupted 7-0 Vicryl sutures with the knots buried. At the conclusion of the case, the patient will used antibiotic ointment three times per day and return in approximately 1-2 weeks for reevaluation.