Excision of lipodermoid (dermolipoma)
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This is Richard Allen at the University of Iowa.
This video demonstrates the excision of a temporal lipodermoid or dermolipoma.
In general, one should not operate on these lesions due to the potential complications of dry eye and strabismus. However, in cases where the lesion is noticeable with the eyelids in the normal anatomical position or in cases of intractable ocular irritation, I will consider surgery as long as the patient is fully informed of the potential complications.
The area is anesthetized and Westcott scissors are used to make an incision just medial to the lesion through the conjunctiva.
Dissection is then carried out on either side of the lesion. Anteriorly, the dissection is performed between the conjunctival covering and the underlying lesion. I do not excise any conjunctiva for fear of creating a cicatricial strabismus.
Dissection should not be carried out too far superiorly, which would risk damage to the lacrimal gland ductules. I would rather leave some of the lesion superiorly than take the risk of causing a chronic dry eye.
Again, the conjunctiva should be conserved with dissection along the surface of the lipodermoid, retaining the overlying conjunctiva.
On the posterior surface of the lipodermoid, the dissection will be carried out between the lipodermoid and the Tenon's. One should be careful of dissection too close to the lateral rectus muscle which could result in post-operative strabismus. If necessary, a muscle hook can be placed to identify the muscle. The goal here is conservative excision without causing post-operative problems.
I usually counsel patients that the color of the area will be similar post-operatively, but the thickness will be improved. Additional dissection is performed until the lipodermoid can be excised.
The conjunctiva can then be closed with superficial interrupted 7-0 Vicryl sutures placed in a buried fashion. As I said, it is best to not do anything to these lesions if possible. If the patients are fully informed of the possible risks, excision can be performed, but a conservative approach is likely wisest.
At the conclusion of the case, antibiotic ointment is placed into the eye and the patient returns in one week for reevaluation. Main risks of the procedure are causing chronic dry eye and strabismus.