How is a trans-corneal reduction procedure performed?

• A. Sedate and place in dorsal recumbency
• B. Apply proparacaine and copious gonak (viscous) gel to cornea
• C. Utilize cotton tip applicator with gentle pressure on corneal moving dorsal to ventral to reposition lens behind iris and ensure appropriate position
• D. Latanoprost to keep behind iris

Answer: (C)

The main idea is repositioning a luxated lens through direct corneal manipulation. In this trans-corneal reduction, you use a sterile cotton-tipped applicator to apply gentle pressure on the cornea from dorsal to ventral, guiding the dislocated lens back behind the iris into its proper position behind the pupil. This technique directly achieves the realignment, which other steps don’t accomplish by themselves. Adequate topical anesthesia and careful handling are important to protect the cornea and minimize discomfort, but the critical action is the controlled corneal pressure that moves the lens into place. After repositioning is achieved, you verify that the lens is stable behind the iris and in the correct location; other approaches that rely on sedatives alone or on glaucoma meds won’t substitute for this mechanical realignment.