BSS
Balanced Salt Solution: an irrigant for the eye
Cataract
A pathological condition in which the crystaline lense becomes opaque, or cloudy, due to age or trauma
Chalazion
A small, red, inflamed lump that can be located on the inner or outer surface of the eyelid--due to a blocked meibomian (sebaceous) gland
dacryo
referring to the lacrimal apparatus of the eye (tears)
diathermy
The use of high frequency electromagnetic currents to cauterize blood vessels and destroy neoplasms
enucleation
usually refers to the removal of the eye
Excision of an eye
extracapsular cataract extraction
an incision in the side of the cornea to replace the diseased lense with an intraocular implant
intracapsular cataract extraction
Injection of alpha-chymotripsin into the posterior chamber to digest the suspensory ligaments and entirely remove the lense
extrinsic muscles
the six muscles of the eye that come from the bones of the orbit and function to move the eye in various directions
globe
the eyeball in its entirety
iridotomy
incision of the iris
kerato
lense
lacrimal
a bone next to the eye that has a hole for the tears to drain into the nose
ocutome
a cutting system for vitrectomy
strabismus
misalignment of the eyes; prevents tracking visual objects
misalignment or deviation of the eyes, or "crossed eye
trephine
a cyclindrical saw used for cutting a circular piece of bone
tunic
an investing membrane
Meibomian gland (embedded sebaceous gland in tarsus cartilage plates)
pass a curette to excise
Lateral canthotomy
Use straight tenotomy scissors or iris scissors
Canthal tendon reattached to tarsus
Pass 4-0 or 5-0 nonabsorbable suture on a Castroviejo needle holder
Irrigation to protect and maintain moist conjunctiva
BSS
Small Vessels and fat pockets
Use needle tip ESU
Blot or hold pressure
Weck-Cell sponge
What is used to evert the eyelid for a chalazion?
Chalazion clamp
Ectropion
turning outward (eversion) of the lower eyelid
Entropion
turning inward (inversion) of the lower eyelid
What is Involutional entropion:
apposition of hte lid to the globe changes due to atrophy
What is congenital entropion
due to hypertrophy of oculi muscle
What are the types of entropion?
Involutional entropion and Congenital entropion
Dacryocystorhinostomy
performed to open a blocked drainage system for tears
Why is topical anesthesia used even if a general anesthetic is in use?
To minimize bleeding
Diplopia
Double vision
Heterotropia
strabismus: a condition in which the eyes are not properly aligned with each other
esotropia
cross eyed
exotropia
wall eyed
amblyopic
lazy eyed
Why would the adjustable suture technique for surgery be beneficial?
it allows more accurate alignment and placement; the field of vision is more exact
What layers of the eye are incised and must be closed at the end of the strabismus correction procedure?
the conjunctiva, the fascia, and the muscle
What intraocular gas(es) may be used in the treatment of retinal tears?
C3F8 (perfluoropropane) and SF6 (Sulfur hexafluoride)
What is the purpose of the intraocular gas that may be injected during this procedure?
to create pressure on the retina while subretinal fluid is reabsorbed and scars form
Scleral buckle
procedure used to fix retinal detachment
Why would a scleral buckle be accompanied by a vitrectomy?
to prevent subretinal fluid drainage
What can be used to replace vitreous humor?
Healon
What is the ocutome used for?
used to cut and aspirate vitreous
3 indications for enucleation:
1. malignant neoplasm
2. penetrating wounds
3. when the eye has been so extensively damaged
Evisceration
Allows remnants of eye to remain
Patient may wear a prosthetic eye that will have mobility and a better cosmetic result
A radial keratotomy is done to correct
myopia
OD
ocular dextrad (right eye)
OS
ocular sinistrad (left eye)
The medication which can be added to a local anesthetic to increase absorption and dispersion/spreading is:
Hyaluronidase (Wydase)
Aphakia
the absence of the lense
tonometer
instrument used to measure IOP
Pterygium excision
Removal of a fleshy encroachment on the cornea.
Scleral shield
plastic cover used to protect the cornea during certain eye operations
Medications used during the eye procedure are usually
CLEAR
The operative microscope in ophthalmic surgery often uses which objective lens distance
175-mm objective lense
When suturing the cornea following an intraocular procedure, which material would most commonly be used?
10-0 nylon
Why is CO2 LASER is not used for eye surgery?
the CO2 LASER is a "water-absorbing" LASER and would coagulate the vitreous.
anterior cavity
from the cornea to the lense
posterior cavity
from the lense to the optic nerve
What type of knife is most common inside the eye
beaver knife blades
Bowman probe used to
open the lacrimal tear duct
Phacoemulsifier
uses ultrasonic energy to fragment the hard lens material, which then can be aspirated from the eye
operating microscope
magnifies surgical site through use of lenses
Vitreoretinal system
provides light, diathermy, suction, and intraoperative access to the surgeon
Argon or Nd:YAG laser
used for photocoagulation or photodynamic therapy (need glasses specific to laser)
Cryotherapy unit
uses localized cold temperature to seal tears and holes much as a diathermy unit; CO2 gas passed is under pressure through flexible tubes to the tip of a probe
What is the prep solution for eye surgery?
usualy betadine
Where is the mayo stand usually located in eye surgery?
neck/chest of the patient
Where is local anesthesia usually injected?
behind the eyeball
What sort of hypodermic needles will be needed in eye surgery?
27- and 30-gauge disposable needles, straight and angled
Why should you avoid pooling of prep solution on or near the eye?
because all prep solutions are flamable
What type of adhesive backed drape is used in eye surgery?
1020 drape
Eyelid or conjunctiva procedures utilize what kind of drape?
split sheet drape
Prep parimeters
Hairline to inferior mandibular border and from the anterior auricular border to beyond the midline.
Cleanse eyelid first, then eyelashes (sterile swabs), brow and skin
What are steps to Chalazion excision?
Eyelid everted using chalazion clamp
Incision made with #11 or #15 blade
Orbicularis muscle incised to expose meibomian gland
Gland incised; lesion curretted
ESU to control bleeding
Wound left open to drain; eye pad applied
What are steps to Entropion repair?
A marginal strip of lid is overlapped to estimate the amount of lid shortening.
A tarsal incision is made, and 4-0 traction sutures are placed in the conjunctiva and the lower lid. The redundant tissue is removed.
Double-arm sutures are passed anterior t
In an Iridectomy, why would sponges be soaked in chemotheraputic agent 5-FU and mitomyocin?
to decrease postoperative fibrosis
What is the purpose of an Iridectomy?
to reestablish communication between the anterior and posterior chambers, relieving pupillary block, and to reestablish the outflow of aqueous humor through the Schlemm canal
Muscle Resection
To strengthen a muscle, a section of the muscle or tendon may be removed to make it shorter
Muscle Recession
To weaken a muscle, it is reattached at a point farther toward the back of the eye.
In strabismus resection/recession, why are both eyes draped?
for comparison purposes
After anesthesia has worn off in strabismus correction, but not more than 24 hours later
Adjustments performed, 1% tetracaine instilled,and sutures are adjusted to proper recession while the patient reports vision status
When proper visual alignment is achieved, the sutures are knotted and cut
Retinal detachment occurs when
the liquid in the vitreous cavity passes through a retinal tear, separating the retina from the choroid
During a scleral buckle,
silicone plastic or sponge is sewn onto the sclera at the site of a retinal tear, which pushes the sclera toward the retinal tear.
the buckle closes the tear and reduces the eyeball circumference.
All implants are soaked in
antibiotic solution
If working on only one muscle, or no muscle at all, why are all four extrinsic muscles tagged?
to allow the globe to be rotated to the desired position
Either the __________ (cold) or __________ (heat) is used to seal any tears in the retina. ______________
Cryoprobe, diathermy, cryoprobe is more commonly used
gentamicin
antibiotic
DCR
Dacryocystorhinostomy
Prior to induction of anesthesia in keratoplasty,
the surgical technologist should always confirm the donor cornea has arrived
What instruments are used to determine the correct size of cornea?
Calipers
A trephine ("tree-fine") is used to
make corneal cut around cornea and into anterior chamber
May need corneal scissors or a diamond knife to complete the cut
Success rate of corneal transplants is very
high
ICCE
Large incision, entire capsule removed; suture required to close incision
ECCE
Small incision, only the lens is removed; incision is self-sealing with no sutures required
Phacoemulsification
Irrigation/aspiration technique
Ultrasonic energy fragments the lens while simultaneously irrigating and aspirating the fragments
Vitrectomy
Performed to remove hemorrhage so the surgeon can view whether there is a retinal tear or detachment
Fragmatome
ultrasonic instrument with aspiration; used to remove cloudy lens, which obstructs the view of the retina
Position for vitrectomy
Supine with slight reverse Trendelenburg with neck extended and supported on a roll sheet
TED hose should be used
Silicone oil
sometimes used instead of gas
Silicone oil is useful ____________________, but _______________________.
when long-term support of the retina is required, may promote cataracts and damage to cornea
Endophotocoagulation
Uses a laser to treat intraocular structures
Often used to treat retinal tears
Frequently used to treat diabetic retinopathy
Lensectomy
Removal of the eye's crystalline lens during a vitrectomy procedure.
Performed when surgeon cannot visualize the internal structures of the eye.
Superior Rectus
Elevates the eye and turns it medially
Lateral Rectus
Moves eye laterally
Inferior Oblique
Elevates eye/ turns it laterally
Inferior Rectus
Depresses and adducts the eye
Medial Rectus
Moves eye medially
Superior Oblique
Depresses eye and turns it laterally
Trochlea
Acts as pulley for the Superior Oblique