Research Article
Volume 6 Issue 6 - 2020
Facilitated Lid Anaesthesia Technique (FLAT)
Melvin LH Ling2,7, Michael Lin5,7, Nicholas Xiradis1,9, Elizabeth LS Wong1,2, Sascha KR Spencer1,2, Log Tung Lai3,4, Yunding Li4, Zhi Wei Lim2, Timothy R Holmes2, Brian Leatherbarrow6, Ian C Francis1,2,4,5 and Geoffrey Wilcsek1,2,5,8*
1Ocular Plastics Unit, Prince of Wales Hospital, Sydney, Australia
2The University of New South Wales, Australia
3The University of Newcastle, Australia
4Northern Beaches Hospital, Sydney, Australia
5Chatswood Eye Specialists, Sydney, Australia
6Honorary Consultant Ophthalmic and Oculoplastic Surgeon, Manchester Royal Eye Hospital, United Kingdom
7Sydney Eye Hospital, Sydney, Australia
8Macquarie University Hospital, Sydney, Australia
9Bond University, Australia
*Corresponding Author: Geoffrey Wilcsek, Associate Professor, Chatswood Eye Specialists, Sydney, Australia.
Received: May 13, 2020; Published: May 29, 2020


Aims: Management of chalazia and many other eyelid abnormalities involves surgical procedures performed by most Ophthalmologists in an outpatient setting. A novel but straightforward technique is described, that delivers local infiltration eyelid anaesthesia effectively via a convenient subconjunctival route. This technique, entitled by the authors ‘Facilitated Lid Anaesthesia Technique’ (FLAT), aims to minimise patient pain during the anaesthetic infiltration, minimise subcutaneous ecchymosis and tissue swelling, and maximise intraoperative analgesia.

Methods: The ocular surface is initially anaesthetised with topical Oxybuprocaine 0.4% or Tetracaine 1% drops. With the upper lid digitally everted, and using a bent 30-gauge needle, 0.5 - 1 mL of Lignocaine 2% and 1:80,000 Adrenaline is injected into the subconjunctival plane through the conjunctiva immediately superior to the tarsoconjunctival junction. For lower lid anaesthesia, the same technique is used but with digital distraction of the lower lid to expose the palpebral conjunctiva immediately inferior to the tarsus.

Results: FLAT has been utilised for over 24 years by three experienced Ocular Plastic surgeons. The technique is easily mastered and appears to have no disadvantages when compared with traditional subcutaneous infiltration. Patients who have had the standard transcutaneous infiltration of local anaesthesia prior to experiencing FLAT often comment on the reduced amount of pain associated with the infiltration, improved intraoperative analgesia and a reduction in the degree of postoperative bruising associated with FLAT.

Conclusion: FLAT is a simple method of delivery of anaesthetic infiltration for eyelid procedures, and has proven not only to be effective, but it also appears to avoid the recognised adverse effects of transcutaneous infiltration anaesthesia, such as immediate pain, inadequate intraoperative analgesia and post-procedural swelling and bruising.

Keywords: FLAT; Chalazia; Eyelid Infiltration Anaesthesia; Improved Analgesia and Haemostasis


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Citation: Geoffrey Wilcsek., et al. “Facilitated Lid Anaesthesia Technique (FLAT)”. EC Anaesthesia 6.6 (2020): 19-26.

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