D A V I D P . A U S T E N M S c , B S c ( H o n s ) , F C O p t o m , F A A O

SEPTEMBER 24 • 1999 OPTOMETRY TODAY 33

Equipment required:1. Slit lamp biomicroscope2. Anaesthetic drops, e.g. Ophthaine

(Proxymetacaine HCl 0.5%)3. Disposable hypodermic needle. This is

obtained from a sterile syringe pack asshown in Figure 1

4. Surgical gloves if desired5. Tissues and cotton buds6. Topical antibiotic, e.g. Chloromycetin

(Chloramphenical 1%)

Conjunctival concretion removal

Method:1. Place one or two drops of anaesthetic in

the inferior fornix (Figure 2).

A concretion is a degeneration of the conjunctiva and consists of a yellowish-white inclusion cyst found in the fornices orpalpebral 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:

3. Evert the eyelid and inspect theconcretion (Figure 3).

2. Place the patient in position at the slitlamp and ask them to look away fromthe concretion.

4. Open the sterile needle packaging andholding the base between forefinger andthumb, gently push the point of theneedle under the concretion (Figure 4).If it is very near the surface it may be

Figure 1. Hypodermic needle

Figure 3. A concretion

Figure 2. Instilling anaesthetic

Figure 4. Position of needle

lifted away almost like shelling a pea.However, it may be necessary tocarefully incise all, or most of the wayround the concretion, with the sharpside of the needle. The contents maythen be lifted away. Figure 5 shows the

concretion broken into several pieceswhich have been pushed to the lidmargin. The pieces and any blood maythen be mopped up with a tissue orcotton bud (Figure 6).

Figure 6. After removal

5. Optionally, a prophylactic drop ofantibiotic may be instilled (Figure 7).

Figure 7. Instilling the antibiotic

Figure 5. Concentration broken intoseveral pieces

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C O N J U N C T I V A L C O N C R E T I O N R E M O V A L

6. The patient may be asked to return thefollowing day to ensure that there areno complications and healing hasbegun. Figure 8 shows the scarformation 24 hours after the procedure.

Figure 8. Twenty-four hours after removal

ACKNOWLEDGEMENTI am indebted to my patient, Mrs FT, for her permission to usethese digital images.

ABOUT THE AUTHORDavid P. Austen BSc (Hons),MSc, FCOptom, FAAO is inindependent optometric practicein Loughborough, UK. Hepractices with four optometriccolleagues, seven assistants and atechnician.

Mr Austen belongs to manyclinical and political optometricorganisations and has lecturedextensively in contact lenses,advanced clinical techniques andpractice management, both athome and abroad.