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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).
Figure 3. A concretion
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). If it is very near the surface it may be
Figure 1. Hypodermic needle
Method: 1. Place one or two drops of anaesthetic in the inferior fornix (Figure 2).
Figure 6. After removal
2. Place the patient in position at the slit lamp and ask them to look away from the concretion.
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. Figure 5 shows the
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C O N J U N C T I VA L
C O N C R E T I O N
R E M O VA L
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.
ACKNOWLEDGEMENT I am indebted to my patient, Mrs FT, for her permission to use these digital images.
ABOUT THE AUTHOR David P. Austen BSc (Hons), MSc, FCOptom, FAAO is in independent optometric practice in Loughborough, UK. He practices with four optometric colleagues, seven assistants and a technician. Mr Austen belongs to many clinical and political optometric organisations and has lectured extensively in contact lenses, advanced clinical techniques and practice management, both at home and abroad.
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