ABSTRACT
Approach the medial fat pad in a similar fashion. Apply pressure to the globe, prolapse the fat pad ( Fig. 1.14A ), dissect it with the Ocutemp cautery ( Fig. 1.14B ), cauterize the overlying vessels ( Fig. 1.14C ), clamp and excise the fat pad ( Fig. 1.14C-E ), cauterize the stump of fat, and maintain control and observe for bleeding before releasing the hemostat ( Fig. 1.14C and D ). Use bipolar cauterization for hemostasis. The middle fat pad may be removed in a similar fashion ( Fig. 1.15 ). The inferior oblique muscle lies between the medial and middle fat pad and is easily identified and avoided ( Figs. 1.2 and 1.16 ). It is very difficult to cause clinical diplopia by inadvertent injury to the inferior oblique muscle, as any experienced eye muscle surgeon can relate that the inferior oblique muscle continues to function quite well when partially removed. After obtaining hemostasis, inspect the eyelid for contour and symmetry ( Fig. 1.17A and B ). Reattach the conjunctiva and recess it about 5 mm posterior to its original attachment to the tarsus ( Fig. 1.18A and B ). Reattaching the conjunctiva avoids potential pyogenic granuloma formation. Now tighten the lower eyelid, if necessary, with a tarsal strip procedure.
