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Preoperative preparation of the patient's periocular area, commonly referred to as “gross scrub,” should occur in a designated area outside of the surgical suite following anesthetic induction. A laboratory coat should be worn to shield operating room scrub attire from contact with hair and bodily fluids. Artificial tears or antibiotic ophthalmic ointment (without steroidal component) should be generously applied in both eyes to protect the corneas under anesthesia, unless corneal surgery is to be performed, and to prevent hair from entering the eyes. The periocular area is carefully clipped (2–3 inches around globe) using a #40 blade and a small pair of surgery clippers labeled solely for ophthalmic procedures. Presterilized clipper blades are preferred to eliminate the risk of harboring residual bacteria from a prior patient. Adhesive tape is recommended to gently collect residual hair from the surgical site. Superficial dirt and debris are removed using presoaked cotton balls of diluted baby shampoo.

The surgical site should be precleansed using povidone‐iodine solution, the standard antiseptic for ophthalmic surgery, for its ability to kill a broad spectrum of microbes and some spores. Isopropyl alcohol and chlorhexidine diacetate should be avoided. Chlorhexadine diacetate can cause extensive corneal damage and irreversible deafness if used as a facial antiseptic. Betadine‐soaked cotton balls (5% dilution) are applied to cleanse the eyelids and surrounding skin in a concentric manner, carefully with very minimal pressure. Cotton‐tipped applicators are used to remove residual debris and ocular discharge from the conjunctiva and under the eyelids. This process should be repeated twice followed by rinsing with copious amounts of 0.9% saline. Equipment recommended for preoperative periocular surgical preparation and final surgical preparation is listed in Boxes 2.23 and 2.24, and shown in Figures 2.34 and 2.35, respectively.