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PCS V > Exam 1 - Ophthalmic Procedures > Flashcards

Exam 1 - Ophthalmic Procedures Flashcards

1
Q

what are the ideal magnification factors for ophthalmic procedures?

A

2.5-4.5x with a built in light source

comfortable working distance = relaxed arms with straight & upright neck/head

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2
Q

what are the advantages & disadvantages of using an optivisor for magnification?

A

advantages - commonly used & inexpensive

disadvantages - uncomfortable working distance & lacks a light source

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3
Q

what are the pros & cons of using absorbable suture for ophthalmic procedures?

A

pros - don’t need to remove sutures
cons - tissue reaction/inflammation, multifilament > monofilament

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4
Q

what size suture should be used for eyelid procedures?

A

4-0 to 6-0

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5
Q

what are the pros & cons of using monofilament suture for ophthalmic procedures?

A

pros - less tissue reaction
cons - greater memory/stiffness, so greater potential for corneal injury

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6
Q

what is this instrument?

A

derf needle driver - grasp needle around middle/tip of drivers, palm the needle holder, approach tissue with 90 degree angle, roll the wrist

‘right angle, roll, repeat’

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7
Q

what is this? why is it important?

A

bishop harmon 1x2 forceps - most commonly used

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8
Q

what is this instrument? what is it used for?

A

tenotomy scissors - general use scissor for sharp & blunt dissection around the eye

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9
Q

what is this instrument? what is it used for?

A

general operating scissor - cutting suture

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10
Q

what are the 2 reasons lid plates are used?

A

used to stretch & stabilize the eyelid

enables precise incisions

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11
Q

all of these can be used as what?

A

lid plates

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12
Q

what kind of scalpel grip is used for ophthalmic procedures?

A

pencil grip - #15 blade with bard-parker handle

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13
Q

when would you use the eyelid speculum?

A

cherry eye repair

conjunctival biopsy or injection

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14
Q

what ophthalmic procedure might you use a sterilized rubber band for?

A

tarsorrhaphies - used to distribute suture pressure across the eyelid

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15
Q

what ophthalmic procedure might you use a chalazion clamp for?

A

everts & localizes pathology - ectopic cilia

hemostasis - isolates certain tissues to help them stop bleeding, used for debulking & cryotherapy

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16
Q

what positioning should be utilized for ophthalmic procedures for the surgeon & patient?

A

surgeon - sitting with arm/wrist support

patient - cutting surface parallel to the table

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17
Q

what should be done for patient prep for ophthalmic procedures?

A

lubricate ocular surface - prevent corneal ulceration from exposure

lubricate scissors for hair collection

trim eyelashes & periocular hair

safely decontaminate the periocular skin/ocular surface - use a solution or betadine because scrub has alcohol in it

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18
Q

how should betadine be diluted?

A

1:50 with saline - weak tea appearance

alternating rounds of betadine & saline (eyelids - betadine soaked gauze & saline soaked gauze 3 times, ocular surface - betadine flush & eyewash flush 3 times)

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19
Q

what prep solutions should be avoided for ophthalmic procedures?

A

alcohol, chlorohexidine, & betadine scrub

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20
Q

what is the importance of the haired-nonhaired junction of the skin for ophthalmic procedures?

A
  • figure 8 suture begins here!
  • incisions for hotz-celsus entropion repair & transpalpebral enucleation begin here
  • eyelid tacking
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21
Q

what is the surgical relevance of the ‘grey line’ for ophthalmic procedures?

A
  • distichia arise from meibomian gland orifices
  • common location for eyelid tumors
  • figure 8 suture engages this landmark
  • tarsorrhaphy engages this landmark
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22
Q

what is this?

A

eyelid margin - grey line, requires magnification

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23
Q

what is the tarsal plate of the eye?

A

fibrocartilaginous layer that gives structural support to the eyelids & meibomian glands about 5-10mm wide that is lined with palpebral conjunctiva

24
Q

what are all of these pictures of?

A

tarsal plate

25
Q

what is the surgical relevance of the tarsal plate?

A
  • ectopic cilia arise here, most often 12 o’clock
  • holding layer for eyelid margin lacerations/defects
  • meibomian gland tumors often extend into the tarsal plate
26
Q

what is the holding layer for eyelid margin lacerations/defects?

A

tarsal plate

27
Q

identify the anatomic structures labeled 1-4

A
  1. skin - haired non-haired junction
  2. eyelid margin/meibomian glands
  3. tarsal plate & palpebral conjunctiva
  4. loose/unsupported palpebral conjunctiva
28
Q

what is the permanent surgical correction for entropion?

A

holtz-celsus

29
Q

what is a temporary procedure used for entropion repair?

A

tacking using horizontal or vertical mattress sutures

30
Q

what is the holtz-celsus entropion repair?

A

elliptical skin excision made & vertical mattress sutures are placed to surgically correct entropion

31
Q

what is entropion?

A

eyelid inverts in

32
Q

what is the rule of thumb for entropion repair?

A

while the patient is anesthetized, manipulate the eyelid by pulling/rolling out the entropion to what would be a normal position - measure by estimation or callipers

33
Q

what is the goal in temporary tacking in entropion repair?

A

over correct! get the eye comfortable to heal the ulcer

34
Q

what is the preferred suture type for tacking sutures in an entropion repair?

A

4-0 to 5-0 nylon

35
Q

where is the first bite located for tacking in an entropion repair?

A

1-2mm outside of the haired non-haired junction

36
Q

the distance between the first & second bite in tacking for an entropion repair should be what?

A

the distance required to restore normal eyelid position

37
Q

where is your first incision made in a holtz-celsus repair? what about the second? how is the distance between the 2 incisions determined?

A

parallel to lid margin, 1-2mm outside of the haired non-haired junction

2nd incision is curved

distance between the two is the distance required to restore normal eyelid positioning

38
Q

how is closure performed in a holtz-celsus entropion correction?

A

simple interrupted bisecting pattern to prevent dog eyes - start in the middle

39
Q

T/F: in holtz-celsus entropion repair, surgical trauma induces chemosis, causing a mild ectropion which is expected & should resolve by first recheck in 10-14 days

A

true

40
Q

canine eyelid tumors most often demonstrate _____ characteristics & feline eyelid tumors most often demonstrate ______ characteristics

A

benign

malignant

41
Q

after removing an eyelid mass, what should you do?

A

submit it for histopathology

42
Q

what are your 2 options for eyelid mass removal?

A

excision & debulk/cryo

43
Q

what are the pros & cons of using excision for eyelid mass removal?

A

pros - minor anatomic limitations, more aggressive & more often curative relative to debulk/cryo

cons - requires surgical confidence to safely close the eyelid margin & need to protect the incision site/sutures

44
Q

what are the pros & cons of using debulk/cryo therapy for eyelid mass removal?

A

pros - less aggressive but often curative & less post-op concern

cons - requires cryotherapy machine

45
Q

if the size of an eyelid mass is approaching 1/3 the size of the lid margin, what are your concerns?

A

can’t take more than 1/3 without causing functional disturbances - consider rotational graft or referral

46
Q

if an eyelid mass is causing irritation to the ocular surface, what should you do?

A

remove or debulk/cryo

47
Q

what happens if you have an eyelid mass that involves the nasolacrimal ducts or canthus?

A

consider referral

48
Q

why should you avoid wedge incisions in removing eyelid masses?

A

they take unnecessary lid margins - instead make a house shape to preserve a healthy margin

49
Q

what are the 4 key concepts in closing eyelid margin defects?

A
  1. limited debridement
  2. closure must be perfect - figure 8 suture pattern at the margin
  3. avoid full thickness suture bites
  4. tarsus is the holding layer
50
Q

T/F: improper closure of an eyelid margin can cause more complications than they eyelid mass

A

true - excisions & lacerations carry the same concerns

51
Q

what is the purpose of a tarsorrhaphy?

A

temporary treatment for lagophthalmos

52
Q

what is lagophthalmos?

A

incomplete closure of eyelids

53
Q

what are 3 causes of lagophthalmos?

A

cn v dysfunction, cn vii, & proptosis

54
Q

what are the steps for correcting proptosis?

A
  1. lubricate & protect (e-collar)
  2. deep sedation/general anesthesia
  3. monitoring equipment
  4. reduce globe & monitor for vagal reflex - eyelid stay sutures & blunt counter pressure
  5. clip & clean eyelids
  6. perform tarsorrhaphy - usually 2 horizontal mattress sutures
  7. prescribe oral antibiotics, topical antibiotic, & topical atropine
  8. recheck every 7-10 days
  9. remove sutures when orbital symmetry returns (2-4 weeks)
55
Q

what is a common mistake made using cryoepilation for distichia?

A

improper probe placement directly onto the eyelid margin - ineffective

56
Q

how is cryoepilation done for distichia?

A

probe placed on tarsal plate, hold until ice ball reaches meibomian glands then wait until probe thaws & repeat for 2 freeze-thaw cycles then pluck the distichia (hair should easily slide out if follicle was destroyed)

57
Q

what are some common complications of cryoepilation for distichia?

A

marked eyelid swelling & depigmentation (most often temporary)

PCS V (8 decks)

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