This video shows how to remove a conjunctival inclusion cyst, while sparing the overlying conjunctiva.
Surgeon: Dr. Dasa V. Gangadhar, Grene Vision Group, Wichita, Kansas, USA
Dr. Dasa V. Gangadhar: I present a technique for removing conjunctival inclusion cyst while sparing the overlying conjunctiva. Most cysts do not need removed and spontaneously resolve. However some do persist, as in this patient, with a nine month history of two cysts that have created chronic foriegn body sensation.
I first administer a minimal amount of subconjunctival lidocaine 2% with epinephrine. This amount of anesthesia is more than sufficient for the procedure. A small conjunctival buttonhole is made adjacent to the cyst. Blunt tipped Vannas scissors are used for the dissection. As one nears the cyst, it is important to lift the overlying conjunctiva off of and away from the cyst, with gentle spreading of the scissors. The goal is, obviously, to avoid puncturing the wall of the cyst.
As the cyst becomes bared, they want to escape from their scleral location, as evidenced by the smaller cyst spontaneously being extruded. The larger cyst requires a bit more conjunctival dissection. Once the conjunctiva has been removed from the cyst, it can then be gently lifted off the sclera. The cyst wall is beautifully preserved, allowing the entire cyst to be removed in toto. By removing the entirety of the cyst wall, recurrence becomes very unlikely.
The overlying conjunctiva can sometimes be replaced into position without any further manipulation. In this case, I decided to place a single 10-O Vicryl suture to prevent conjunctival retraction. If the cyst wall is broken, a thorough job removing the cyst wall can still allow for an excellent result. This technique works very well with outstanding cosmesis, minimal manipulation, and a rapid recovery.
I’m Dasa Gangadhar, thank you for your attention.