Exam 1 - Ophthalmic Procedures

Question 1

what are the ideal magnification factors for ophthalmic procedures?

Answer 1

2.5-4.5x with a built in light source

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

Question 2

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

Answer 2

advantages - commonly used & inexpensive

disadvantages - uncomfortable working distance & lacks a light source

Question 3

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

Answer 3

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

Question 4

what size suture should be used for eyelid procedures?

Answer 4

4-0 to 6-0

Question 5

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

Answer 5

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

Question 6

what is this instrument?

Answer 6

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’

Question 7

what is this? why is it important?

Answer 7

bishop harmon 1x2 forceps - most commonly used

Question 8

what is this instrument? what is it used for?

Answer 8

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

Question 9

what is this instrument? what is it used for?

Answer 9

general operating scissor - cutting suture

Question 10

what are the 2 reasons lid plates are used?

Answer 10

used to stretch & stabilize the eyelid

enables precise incisions

Question 11

all of these can be used as what?

Answer 11

lid plates

Question 12

what kind of scalpel grip is used for ophthalmic procedures?

Answer 12

pencil grip - #15 blade with bard-parker handle

Question 13

when would you use the eyelid speculum?

Answer 13

cherry eye repair

conjunctival biopsy or injection

Question 14

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

Answer 14

tarsorrhaphies - used to distribute suture pressure across the eyelid

Question 15

what ophthalmic procedure might you use a chalazion clamp for?

Answer 15

everts & localizes pathology - ectopic cilia

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

Question 16

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

Answer 16

surgeon - sitting with arm/wrist support

patient - cutting surface parallel to the table

Question 17

what should be done for patient prep for ophthalmic procedures?

Answer 17

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

Question 18

how should betadine be diluted?

Answer 18

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)

Question 19

what prep solutions should be avoided for ophthalmic procedures?

Answer 19

alcohol, chlorohexidine, & betadine scrub

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

what is this?

Answer 22

eyelid margin - grey line, requires magnification

Question 23

what is the tarsal plate of the eye?

Answer 23

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

Question 24

what are all of these pictures of?

Answer 24

tarsal plate

Question 25

what is the surgical relevance of the tarsal plate?

Answer 25

- 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

Question 26

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

Answer 26

tarsal plate

Question 27

identify the anatomic structures labeled 1-4

Answer 27

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

Question 28

what is the permanent surgical correction for entropion?

Answer 28

holtz-celsus

Question 29

what is a temporary procedure used for entropion repair?

Answer 29

tacking using horizontal or vertical mattress sutures

Question 30

what is the holtz-celsus entropion repair?

Answer 30

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

Question 31

what is entropion?

Answer 31

eyelid inverts in

Question 32

what is the rule of thumb for entropion repair?

Answer 32

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

Question 33

what is the goal in temporary tacking in entropion repair?

Answer 33

over correct! get the eye comfortable to heal the ulcer

Question 34

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

Answer 34

4-0 to 5-0 nylon

Question 35

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

Answer 35

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

Question 36

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

Answer 36

the distance required to restore normal eyelid position

Question 37

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

Answer 37

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

Question 38

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

Answer 38

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

Question 39

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

Answer 39

true

Question 40

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

Answer 40

benign malignant

Question 41

after removing an eyelid mass, what should you do?

Answer 41

submit it for histopathology

Question 42

what are your 2 options for eyelid mass removal?

Answer 42

excision & debulk/cryo

Question 43

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

Answer 43

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

Question 44

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

Answer 44

pros - less aggressive but often curative & less post-op concern cons - requires cryotherapy machine

Question 45

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

Answer 45

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

Question 46

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

Answer 46

remove or debulk/cryo

Question 47

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

Answer 47

consider referral

Question 48

why should you avoid wedge incisions in removing eyelid masses?

Answer 48

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

Question 49

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

Answer 49

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

Question 50

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

Answer 50

true - excisions & lacerations carry the same concerns

Question 51

what is the purpose of a tarsorrhaphy?

Answer 51

temporary treatment for lagophthalmos

Question 52

what is lagophthalmos?

Answer 52

incomplete closure of eyelids

Question 53

what are 3 causes of lagophthalmos?

Answer 53

cn v dysfunction, cn vii, & proptosis

Question 54

what are the steps for correcting proptosis?

Answer 54

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)

Question 55

what is a common mistake made using cryoepilation for distichia?

Answer 55

improper probe placement directly onto the eyelid margin - ineffective

Question 56

how is cryoepilation done for distichia?

Answer 56

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)

Question 57

what are some common complications of cryoepilation for distichia?

Answer 57

marked eyelid swelling & depigmentation (most often temporary)