This document discusses the anatomy and procedures related to the eye and ocular adnexa. It describes the main anatomical structures of the eyeball, including the sclera, cornea, iris, pupil, choroid, retina, optic nerve and vitreous humor. It also discusses the three types of eye removals - evisceration, enucleation and exenteration. The majority of eye procedures today use lasers instead of knives and are performed microscopically through small incisions. Common procedures include cataract surgery, injections to numb the eye, and surgeries on the iris and trabecular meshwork to treat glaucoma.

1. Eye and Ocular Adnexa
Lamon Willis

2. Anatomy

3. Anatomy
•Eyeball – an inch (25mm) in diameter
• Sclera – white of the eye
• Cornea – transparent
• Anterior chamber
• Pupil and Iris
• Choroid – vascular layer
• Retina – pigmented nerve layer

4. Anatomy
•Optic nerve and Optic disc
• Iris – regulates light entering
• Pupil
• Vitreous humor – fills posterior segment
• Ciliary body – suspensory ligaments of lens
• Lens – changes shape

5. Anatomy
•Conjunctiva
• pink eye
• cul-de-sac
•Muscles
• external

6. Anatomy
•Lacrimal gland
•Glaucoma
• intraocular pressure
•Refraction
•20/20

7. Anatomy
•External ear
• tragus
• auricle or pinna
•Middle ear
• Tympanic membrane
• Ossicles – malleus, incus, stapes
• Eustachian tube
•Oval window

8. Anatomy
•Inner ear
• Labyrinth
• Membranous labyrinth – hair cells
• Vibrations into nerve impulse
• Cochlea, Vestibule, Semicircular canal
• Balance – utricle, saccule
• Oval window, round window

9. CPT Procedures
•An eye typically is removed for one of three reasons:
1. the eye has a malignancy;
2. the eye is blind and very painful, or
3. the eye is blind and disfiguring.

10. CPT Procedures
•There are three types of removals (65091–65114):
1. Evisceration—The contents of the eyeball are scooped
out but the sclera shell remains connected to the eye
muscles, so the prosthesis, fitted into the globe, will
have natural movement.
2. Enucleation—The connections (muscles, vessels, and
optic nerve) are severed and the entire eyeball is
removed en mass.

11. CPT Procedures
3. Exenteration—Surrounding skin, fat, muscle and bone
is removed.
•In any removal, a temporary implant may be placed to
protect the void that may later hold a permanent
implant.
•This temporary implant is included in the procedure
and not reported separately.
•The implant codes reference permanent implants with
aesthetic properties.

12. CPT Procedures
•Today, whenever a laser can be used to surgically
cauterize, cut, destroy, or repair the eye, it will be used
instead of a knife.
•When you are reviewing the codes in CPT’s Eye and
Ocular Adnexa section, assume any procedure with a
laser approach is preferred to an open approach.

13. CPT Procedures
•Some surgeries require incisions.
•Removal of a lens with a cataract requires an incision,
so the lens can be extracted and an IOL inserted.
•Even so, cataract surgery is done microscopically
today, and tiny incisions in the limbus are all that is
required.

14. CPT Procedures
•Injections are sometimes required to numb the eye.
•A retrobulbar or Tenon’s capsule injection are two
common approaches for delivery of anesthetic.
•These nerve blocks are bundled into the procedures
and not reported separately.

15. CPT Procedures
•The majority of procedures performed on the anterior
segment of the eye are microsurgeries performed
using an operating microscope.
•The scope, otherwise reported with 69990, would not
be reported separately.

16. CPT Procedures
•Surgeries on the iris and trabecular meshwork,
including goniotomy, are usually a therapeutic
treatment for glaucoma to improve the flow of
aqueous in the eye.
•Sometimes aqueous is removed for therapy in
paracentesis. This procedure also can be performed
diagnostically.

17. CPT Procedures
• There are many procedures performed on the ocular
adnexa.
• The extraocular muscles may be lengthened or shortened.
• In some cases, the procedure is not completed until the
patient is awakened and lengthy sutures extruding from the
back of the eye adjusted to ensure perfect binocular vision.
• These adjustable sutures are reported with add-on code
+67335.

18. CPT Procedures
•The eyelids and conjunctiva are included in the
adnexal codes.
•In prosthetics following evisceration, the conjunctiva
may traverse an artificial cornea.
•When conjunctiva is damaged, buccal mucosa may be
harvested and used as a graft (68325).

19. CPT Procedures
•Procedures to remove excess skin from the eyelid
(blepharoplasty) are found in the integumentary
chapter.
•Blepharoplasty codes in the Eye and Adnexa section
involve more complex structures within the eye.