Ophtalmology 2 Flashcards
Function of third eyelid?
- Protection of cornea
- Distribution of tear film
- Nictitans gland contributes about 30-40% of the aqueous
component of the tear film
What diseases fo the third eyelid do we see?
- Nictitans gland prolapse
- Loss of anchoring to orbit
- May be associated with gland inflammation
- Scrolling of the third eyelid cartilage
- Neurological disease
- Prolapse is a clinical sign of:
* Horner’s syndrome
* Haws syndrome
- Prolapse is a clinical sign of:
Describe prolapse nictitans gland?
- AKA Cherry eye
- Poor anchoring of gland to orbital periosteum
- Inflammation of the gland causing a loss of anchoring
ligament.
What techniques available for cherry eye repair?
- Periosteal tie down
- Globe anchoring
- Variations on pocket
- Permanent suture
technique for cherry eye should be?
- Reproducible
- Maintain normal function
- Third eyelid movement
- Tear production
What do you need for prolapse sx?
- Loupes
- Suture material
- Polyglactin 910 0.7 metric (6/0)
- Surgical kit
- Fine mosquito artery forceps
* Conjunctival forceps
- Fine mosquito artery forceps
- Scapel blade
- 15 or 15T
Step 1 of cheery eye replacement?
Evert.& stabilise third eyelid
Where should we incise? (Step 2)
- Parallel to eyelid margin
- 2 non converging incisions
- Distal to the top of the third eyelid cartilage away from the border
- Across base of gland 8- 12mm from limbus
- INCISIONS MUST EXTEND INTO SUBCONJUNCTIVAL FASCIA
Step 3 (suturing) ?
step 4 Suturing?
- Pass back through third eyelid
- Tie off with a bite of external conjunctiva
INITIAL appearance post third eyelid repair?
- Swelling is normal
- Third eyelid margin must
not be folded
Cherry eye post-op ?
Tx: anti-inf +/- topical ABs
Check up 1 week later - noswelling should be present
What is scrolling fo cartilage of third eyelid?
- Unknown mechanism
- ?lack of support of external eyelids
- ?overlong third eyelid
- T Shaped cartilage
- Thick and wide base
- Narrow and thin top
What does the repair look like?
Cautery use?
- Used for top part of T
- Avoids incision of third eyelid margin
- Instant response
Corneal surgical techniques?
- Foreign bodies
- Indolent ulceration
- Keratectomy
- Direct closure
- Grafting -> Conjunctiva, Corneal transposition, Transplants
Foreign bodies ?
- Usually plant based
- Penetration may be associated with a yelp at the time of the injury
- Most patients come back home and go into hiding
What are the 4 phases of corneal healing?
- LAtent
- Migration
- Proliferation
- cell substrate attachment
Describe SCCED? (Spontaneous Chronic Corneal Epithelial Deficit) - Indolent ulceration
- Common (french bulldogs, boxers, pembroke corgis)
- Superficial
- Non healing
- Involving epithelium only e
Tx for SCCED?
- Debride under LA (cotton bud)
- Diamond burr
- Other options )> grid keratotomy, contact lens, third eyelid flap)
- Repeat as necessary
What is alger brush II?
- Disrupts anterior surface of stroma
- Will not bite into deeper stroma (if healthy)
- No risk of penetrating injury
Superficial keratototmy?
Tx for:
- Corneal sequestrum
- Superficial immune mediated keratitis
- Neoplasia
- Non healing superficial chronic corneal epithelial deficit
Assessing for loss of corneal integrity?
IRIS PROLAPSE
- Reduction in aqueous chamber depth
- Hyphaema
- Fibrin
- Seidel Test
When would we expect a good prognosis?
– Sharp laceration
– Early detection
– Iris prolapse
When could we expect a poor prognosis?
– Hyphaema
– Lens penetration
– Loss of cornea
– Rupture involving limbus
– Late presentation
Tx for iris prolapse?
- Direct closure
– +/- grafting - Conservative management
– Minor leaks usually self seal
Third eyelid flap
Temporary Tarsorrhaphy
Describe the conjunctival pedicle graft
- Need magnification
(remember corneal thickness) - Provides immediate support to
cornea - Most useful for deep ulcers,
descemetocoeles and ruptures - Leave 4-6 weeks then section
What are some other forms of conjunctival grafts?
- Hood
- Bridge
- Free island
- 360 degree
How to use amniotic membrane?
- Similar handling to conjunctiva
- Can be placed face down or face up
- Stroma down – incorporated
- Stroma up – bandage that is shed
What does amniotic membrane contain?
anticollagenases, growth factors, suppress
vascularisation, provides a scaffold
-> can double up as scaffold and bandage
Tissue matrix options?
describe corneoconjunctival transposition?
- Better Tectonic support
- Better cosmetic outcome
- Slightly harder to perform
