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6901 > Ophthalmic and Dental Procedures > Flashcards

Ophthalmic and Dental Procedures Flashcards

1
Q

eye - outer layer

A
  • sclera: white, fibrous
    cornea: anterior part of sclera
    conjunctiva: outer cover from limbus to eyelid
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2
Q

eye - middle layer

A
  • choroid: located posteriorly, blood supply to retina
  • iris: controls light entry by changing pupil size, sympathetic=dilate, parasympathetic=constrict
  • ciliary body: secrete aqueous fluid and control shape of lens by tension on zonule of Zinn

*called uveal tract

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3
Q

eye - innermost layer

A
  • retina: converts light impulses to neural impulses

- vitreous gel: attached to blood vessels and optic nerve

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4
Q

caruncle

A

lacrimal duct

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5
Q

IOP

A

10-22 mmHg

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6
Q

three chambers of eye

A
  • anterior: cornea to iris, Schlemms Canal is drainage
  • posterior: iris to lens, formation
  • viterous
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7
Q

myopia versus hyperopia

A

myopia: nearsighted, eye is long and stretched, focal point close to lens
hyperopia: farsighted, eye is short and, focal point far from to lens

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8
Q

muscles of the eye

A
  • four rectus: controlled by oculomotor (III), lateral controlled by abducens (VI), originate at annulus of Zinn
  • two oblique: superior oblique = rotation towards nose by trochlear (IV) inferior oblique = rotation sideways by oculomotor (III)
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9
Q

optic nerve

A
  • CN II

- conveys visual information from retina to occipital lobe

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10
Q

facial nerve

A
  • CN VII
  • branches temporal and zygomatic
  • controls tears and eye lid
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11
Q

vagus nerve

A
  • CN X

- oculocardiac reflex

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12
Q

ophthalmic artery

A
  • first branch from internal carotid
  • medial muscular: medial and inferior rectus, inferior oblique
  • lateral muscular: lateral and superior rectus, and superior oblique
  • ciliary arteries: short posterior and long posterior
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13
Q

techniques to decrease systemic absorption

A
  • close eyes for 60 seconds
  • do not blink
  • pressure on tear outflow canal
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14
Q

ocular - cocaine

A
  • DCR procedures

- controls bleeding

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15
Q

ocular - tetracaine

A
  • ester
  • onset 1 min
  • duration 30 min
  • stinging on application
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16
Q

ocular - proparacaine

A
  • ester
  • onset 15 sec
  • duration 15 min
  • less irritation
17
Q

ocular - hyaluronidase

A

protein enzyme that speeds onset by promoting even spread of local anesthetic

18
Q

ocular anesthesia techniques

A
  • MAC with local, topical, or regional

- general anesthesia

19
Q

ocular blocks - sub-tenon’s capsule

A
  • blunt cannula through small incision in conjunctiva
  • contraindicated in glaucoma patients
  • better for anticoagulated patients
20
Q

ocular blocks - retrobulbar

A
  • behind the globe
  • may need facial block to prevent blinking
  • small volume (2-4 mL)
  • fast onset (2 min)
  • hemorrhage: proptosis (bulging of eye), subconjunctival hemorrhage, increase IOP - use pressure or lateral canthotomy
21
Q

ocular blocks - inferotemporal

A
  • transcutaneously

- transconjunctivally

22
Q

ocular blocks - facial nerve and eyelid block

A
  • orbicularis occuli
  • avoid large volume of agent
  • complications: facial paralysis, hemorrhage
23
Q

ocular blocks - peribulbar

A
  • outside of the cone
  • larger volume (10-12 mL) = increased risk of IOP
  • slower onset (10 min)
24
Q

Honan device

A
  • diffuse local anesthetic, reduce IOP, soften eye
  • 30-40 mmHg for 5 minutes post block

-can manually apply pressure: 30 sec on, 5 sec off

25
Q

ocular blocks - complications

A
  • oculocardiac reflex
  • hemorrhage
  • globe puncture
  • retinal artery occlusion
  • optic nerve penetration
  • intravascular injection
26
Q

ocular blocks - intravascular penetration

A

-contralateral pupil constricted before injection, dilated after

  • painless vision loss
  • disorientation
  • vomiting
  • aphasia
  • hemiplegia
  • unconsciousness
  • convulsions
  • arrest

*support cardiac and respiratory systems

27
Q

ocular blocks - globe puncture

A
  • increased resistance to injection
  • immediate dilation
  • rapid increase in IOP, than decrease
  • edematous cornea
  • subconjunctival and intraocular hemorrhage
  • pain
  • agitation
28
Q

oculocardiac reflex

A
  • trigeminal (V) afferent, vagus (X) efferent
  • bradycardia
  • stop surgical simulation and give IV atropine
29
Q

strabismus

A
  • oculocardiac reflex
  • n/v
  • avoid succinylcholine = higher risk for malignant hyperthermia
30
Q

retinal surgery

A
  • sulfur hexafluoride to tamponade the retina

- avoid nitrous oxide

31
Q

glaucoma

A
  • avoid increases in IOP
  • give miotic drugs, avoid mydriatic drugs (atropine gtts, scopolamine)
  • acute: painful, treatment with mannitol or acetazolamide
  • contraindications: retrobulbar block, awake intubation, succinylcholine
32
Q

dental procedures

A
  • empty stomach before emergence
  • nasal RAE
  • **make sure throat packs are removed

6901 (18 decks)

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