皮膚病毒疣外觀 appearance of the viral wart
Close up view, side view 近鏡視圖，側面視圖
Close up view, side view 近鏡視圖，側面視圖
the appearance of the wound immediately post-op 術後即時傷口外觀
Close-up and side view of the wound immediately post-op 術後即時傷口外觀，近鏡視圖，側面視圖
The appearance of the scar 3 months post-op and the appearace will further improve in the following 3-5 months. 術後三個月瘢痕外觀，並且在接下來三至五個月內外觀將會進一步改善。
病例報告：二氧化碳雷射消融下眼瞼（下眼皮）皮膚病毒疣
患者資料 患者為 65 歲男性，右下眼瞼皮膚腫塊病史三年。既往病史無特殊。整個病程中病灶無症狀。
臨床特徵 檢查顯示病灶為一個堅實、隆起的結節，位置非常接近下眼瞼邊緣。表面不規則，無壓痛，亦無分泌物或潰瘍。周圍眼瞼皮膚完整，無局部侵犯或區域淋巴結腫大。
技術操作：二氧化碳雷射消融 在局部麻醉及金屬內眼盾保護下，使用二氧化碳雷射對病灶進行消融。雷射光束精準地逐層汽化病灶，確保徹底去除至基底。採用超脈衝模式以減少周邊損傷並提供良好的止血效果。能量設定為 2W 至 4W，由低端開始並逐步調整。使用小光點（0.3 mm）以確保對疣組織的精準定位及深度控制。操作過程中注意保留鄰近正常組織，並維持眼瞼邊緣的完整性。
即時傷口外觀 消融後，傷口床清晰且邊界分明，因雷射的凝固作用而出血極少。眼瞼邊緣未受破壞，保存良好。
術後三個月瘢痕外觀 三個月後，手術部位癒合呈淡粉色，預期在接下來數月會逐漸淡化。瘢痕平坦，無增生或萎縮。眼瞼功能保持正常，無外翻、內翻或閉合不全。美容效果令人滿意，雙眼對稱性良好。
Case Report: CO₂ Laser Ablation of Lower Eyelid Skin Viral Wart
Patient Profile A 65‑year‑old male presented with a three‑year history of a skin lump on his right lower eyelid. He reported no significant past medical history. The lesion was asymptomatic throughout its course.
Clinical Features On examination, the lesion appeared as a firm, raised nodule located very close to the margin of the lower eyelid. The surface was irregular and non‑tender, with no associated discharge or ulceration. The surrounding eyelid skin was intact, and there was no evidence of local invasion or regional lymphadenopathy.
Technical Procedure: CO₂ Laser Ablation Under local anesthesia with metal internal eyeshield as ocular protection, a CO₂ laser was employed to ablate the lesion. The laser beam was directed precisely to vaporize the lesion layer by layer, ensuring complete removal down to its base. Ultra pulse was used to ensure minimal peripheral damage and provide good haemostatic control. Energy used was from 2W to 4W, start at lower end and titrate upwards. Small spot size (0.3mm) was used to ensure accurate targeting of wart tissue and and precise control of depth. Care was taken to preserve adjacent normal tissue and maintain the continuity of the eyelid margin.
Immediate Wound Appearance Following ablation, the wound bed appeared clean and sharply demarcated, with minimal bleeding due to the coagulative effect of the CO₂ laser. The eyelid margin was not disrupted and well preserved.
Scar Appearance at 3 Months Post‑Operation At three months, the surgical site had healed with a faint pink discoloration which would further fade in the coming few months. The scar was flat, without hypertrophy or atrophy. Eyelid function was preserved, with no evidence of ectropion, entropion, or lagophthalmos. The cosmetic outcome was satisfactory, with symmetry maintained between both eyes.
二氧化碳雷射手術亮點：下眼瞼皮膚病毒疣
- 安全性 — 尤其是眼球保護 手術在局部麻醉下進行，並使用金屬內眼盾作為眼球保護。這確保雷射能量僅作用於病灶組織，避免任何意外的眼球損傷。整個過程中，患者安全始終被置於首位。
- 止血控制 二氧化碳雷射在汽化組織的同時，能有效凝固小血管，提供優異的止血效果。這大幅減少了術中出血，保持清晰的手術視野，並降低術後瘀青或腫脹的風險。
- 眼瞼邊緣的保存 透過精準的雷射參數（小光點、超脈衝模式、能量逐步調整），能準確消融疣組織，同時避免損傷鄰近正常皮膚。眼瞼邊緣的完整性得以維持，避免了形態或功能上的破壞。
- 美容效果的保存 消融後的傷口邊界清晰，癒合後形成細緻、平坦的瘢痕，自然隱藏於眼瞼皺褶中。三個月後瘢痕呈淡粉色，預期在接下來數月會進一步淡化。美容效果令人滿意，雙眼保持良好對稱。
- 功能保存 術後眼瞼功能完全保留。無外翻（ectropion）、內翻（entropion）、閉合不全（lagophthalmos）或其他功能障礙。患者術後仍能正常閉眼，眼球表面獲得良好保護。
✨ 總結 此病例突顯了二氧化碳雷射在治療眼周病灶時的優勢：安全性、止血效果、邊緣保存、美容精緻、功能完整。透過精細的技術與嚴謹的操作，能在敏感的眼瞼區域達到最佳的臨床與美學結果。
Highlights of CO₂ Laser Surgery for Lower Eyelid Viral Wart
- Safety – Especially Ocular Protection The procedure was performed under local anesthesia with a metal internal eyeshield in place to safeguard the globe. This ensured that the laser beam was confined to the target tissue, eliminating the risk of accidental ocular injury. Patient safety was prioritized throughout.
- Haemostatic Control The CO₂ laser provided excellent haemostatic effect by simultaneously vaporizing tissue and coagulating small vessels. This minimized intraoperative bleeding, maintained a clear surgical field, and reduced postoperative bruising or swelling.
- Preservation of the Eyelid Margin Precision settings (small spot size, ultra‑pulse mode, titrated energy) allowed accurate ablation of the wart while sparing adjacent normal tissue. The continuity of the eyelid margin was preserved, preventing distortion or functional compromise.
- Cosmetic Preservation The wound bed was sharply demarcated and healed with a fine, flat scar that blended naturally into the eyelid crease. At three months, the scar showed faint pink coloration, expected to fade further over the next few months. The cosmetic outcome was highly satisfactory, maintaining symmetry between both eyes.
- Functional Preservation Eyelid function remained intact postoperatively. There was no evidence of ectropion, entropion, lagophthalmos, or impaired closure. The patient retained full eyelid mobility and protection of the ocular surface.
✨ Summary: This case highlights how meticulous technique with CO₂ laser — combining safety, haemostasis, margin preservation, cosmetic finesse, and functional integrity — can achieve an optimal outcome in treating delicate periocular lesions.