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CHAPTER 28
lnferomedial Subpalpebral Lavage Tube Placement
Laurence E. Galle
conjunctiva. The palpebral conjunctiva is firmly
INDICATIONS adherent to tl1e eyelid at the eyelid margin and
becomes loosely attached toward the conjunctival
A subpalpebral lavage tube is indicated to facili- fornix. In the ventral aspect of the medial can thus,
tate the administration of topical ophthalmic the conjunctiva in the fornix reflects onto the
solutions.l" anterior surface of the third eyelid. The conjunc-
tiva of the third eyelid again reflects into a fornix
on its posterior surface before becoming associ-
EQUIPMENT ated with the globe as it becomes the bulbar
conjunctiva7 (Figure 28-2). The inferomedial sub-
Needle drivers, general operating scissors, 12- palpebral lavage tube will be positioned such that
gauge trocar, and one sterile silicone subpalpebral its footplate is in the inferomedial conjunctival
lavage tube device approximately 90 cm long with fornix between the ventral eyelid and the third
a 1-cm-diameter footplate are needed2•3 (Figure
eyelid.3
28-1). The subpalpebral lavage tube device may be
purchased from commercial sources or manufac-
tured by the surgeon from appropriate materials. PROCEDURE
The surgeon should ensure patency of the sub-
POSITIONING AND PREPARATION palpebral lavage tube prior to attempting to insert
it into the patient. The tip of a 12-gauge trocar
Subpalpebral lavage tubes can be placed in is directed deep into the conjunctival fornix
sedated patients using appropriate nerve blocks between the ventral eyelid and third eyelid. The
to provide eyelid akinesia and sensory anesthesia index finger is used to guide the trocar and
including topical corneal anesthesia. prevent injury of the globe with the trocar (Figure
28-3). The trocar is advanced through the con-
junctival fornix and through the skin ventral to
ANATOMY the medial canthus. A stainless steel thimble may
be used to advance the trocar, and needle drivers
Ventromedial subpalpebral lavage tube placement may be placed adjacent to the exit site of the trocar
requires knowledge of the lower eyelid, medial through the skin to provide counterpressure to
canthus, third eyelid, and orbital rim. The poste- facilitate trocar placement. The free end of the
rior surface of the ventral eyelid is the palpebral subpalpebral lavage tube is inserted externally
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