Conjunctival Concretion Removal


by David P Austen

A concretion is a degeneration of the conjunctiva and consists of a yellowish-white inclusion cyst found in the fornices or palpebral conjunctiva and is filled with keratin and epithelial debris. Concretions are usually associated with advancing years and only give trouble if they harden and erode the overlying conjunctiva and cause a foreign body sensation. They are easily inspected by everting the lids and may be removed by excision as follows:

Equipment required:

  1. Slit lamp biomicroscope
  2. Anaesthetic drops, e.g. Minims® Benoxinate 0.4%
  3. Disposable hypodermic needle. This is obtained from a sterile syringe pack as shown in Figure 1
    Fig 1
  4. Surgical gloves if desired
  5. Tissues and cotton buds
  6. Topical antibiotic, e.g. Chloramphenicol (Sno Phenicol® 0.5%) or (Chloromycetin® Eye Ointment 0.5%)

Method:

  1. Place one or two drops of anaesthetic in the inferior fornix (Figure 2).
    Fig 2
  2. Place the patient in position at the slit lamp and ask them to look away from the concretion.
  3. Evert the eyelid and inspect the concretion (Figure 3).
    Fig 3
  4. Open the sterile needle packaging and holding the base between forefinger and thumb gently push the point of the needle under the concretion (Figure 4).
    Fig 4
    If it is very near the surface it may be lifted away almost like shelling a pea. However; it may be necessary to carefully incise all, or most of the way round the concretion, with the sharp side of the needle. The contents may then be lifted away.

    Fig 5
    Figure 5 shows the concretion broken into several pieces which have been pushed to the lid margin. The pieces and any blood may then be mopped up with a tissue or cotton bud (Figure 6).
    Fig 6
  5. Optionally, a prophylactic drop of antibiotic may be instilled (Figure 7).
    Fig 7
  6. The patient may be asked to return the following day to ensure that there are no complications and healing has begun. Figure 8 shows the scar formation 24 hours after the procedure.
    Fig 8

ACKNOWLEDGEMENTS


I am indebted to my patient, Mrs Fl for her permission to use these digital images.
and to Optometry Today for permission to republish this paper.