Eyeworld

N MAY 2019 | EYEWORLD | 21 Contact information Gossman: mitchellg@eaofcm.com Safran: safran12@comcast.net PULSE OF OPHTHALMOLOGY by Mitchell Gossman, MD The second question was, "Do you usually inject local anesthetic subcutaneously, sub- conjunctivally, or both for the typical internal chalazion?" The answers were: D uring a busy day of handling serious eye disease, cataract evaluations, and glaucoma follow up, you see a patient with a painless lump of the eyelid—another chalazion. For the patient it is a concern. They want something done and are anxious about surgery. Anything worth doing is worth doing right, with maximum comfort and cure rate. So how are we all doing surgery for the lowly chalazion? A survey was conducted of 88 ophthalmol- ogists who volunteered to participate from the ranks of participants of the ASCRS EyeConnect online community, plus volunteers in North America and worldwide. Responses are anonymous to encourage candor. Totals may not equal 100% due to rounding. The first question was, "What anesthetic do you use?" The responses were: How are we treating chalazia? The ASCRS Clinical Survey has been conducted annually since 2013. The positive impact of data-driven education plans has become apparent. For example, survey data over the past 5 years reveal that there has been an almost 50% reduction in the percentage of respondents who think that 10 or more de- grees of postoperative rotational error in toric IOL patients is acceptable before visual quality and acuity are significantly affected. The data show that increasing physician confidence in a technology drives increased patient access to that technology. For example, the percentage of ASCRS Clinical Survey respondents who currently perform MIGS increased from 16% in 2014 to 49% in 2018. The goal is to continue the ASCRS Med- ical Education Summit on an annual basis to address the shared mission of delivering high-quality education that ultimately improves patient care. continued from page 20 About the doctors Mitchell Gossman, MD Eye Associates of Central Minnesota St. Cloud, Minnesota Steven Safran, MD Lawrenceville, New Jersey Financial interests Gossman: None Safran: None Lidocaine with epinephrine 91% Lidocaine without epinephrine 9% Bupivacaine 0% Topical 0% Epinephrine helps with hemostasis, delays clearing of anesthetic, and is used by the major- ity. Bupivacaine is longer acting but is deemed by 100% to be unnecessary. Subcutaneous only 66% Subconjunctival only 13% Both subcutaneous and subconjunctival 21% Subcutaneous injection is easier to adminis- ter given the easy spreading of tissues but may not provide adequate anesthesia for internal chalazia. However, injecting under the palpebral conjunctiva can be challenging because of the tough tarsus. My own practice is to start subcu- taneously and if necessary augment with some subconjunctival anesthetic. The third question was, "How do you make your incision through the tarsus?" The answers were: A pointed stainless steel blade, such as a #11 Bard-Parker 66% Radiofrequency device, such as the Ellman Surgitron 13% A rounded stainless steel blade, such as a #15 Bard-Parker 21% continued on page 22

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