Ophthalmic Surgery Flashcards
How do you prepare eyelids for surgery?
Lubrication gel
Clip the periorbital hair and eyelids
Scrub periocular area with a 0.2% iodine/saline solution and sterile saline
Clean conjunctiva and nictitating membrane with cotton swab
Irrigate cornea
What should you avoid with surgical preparation of the eyes?
Avoid scrub on the cornea
What are the basic ophthalmic intrustruments?
Barraquer eyelid speculum Jaeger eyelid plate Bishop-Harmon forceps Derf needle holder Stevens tenotomy scissors
What do you do for Hemostasis of the eye?
Direct pressure with cotton tip applicators Wedge shaped cellulose sponges 4x4 sponges Hand held cautery Phenylephrine
What are common surgical disease of the eyelids?
Eyelid lacerations Eyelid tumors Eyelid agenesis Entropion Ectropion
How do you manage eyelid lacerations?
Close in 2 layers
Deep layer: Simple continuous
Skin: Figure 8
What is important for closing the skin of the eyelid?
Place knots away from cornea
What suture should you used in closure of the skin of the eyelid?
5/0 or 6/0 Vicryl
What do you do for a mass of the eyelid that is less than 1/3 the eyelid margin?
treat like a laceration
What is the technique for Canine Eyelid tumor resection?
H shaped resection
What are the techniques for Eyelid Reconstruction?
Single Pedicle advancement flap
Lip to Lid flap
What are the most common feline eyelid tumors?
Squamous cell carcinoma
Eyelid Agenesis
Upper lateral or lower central eyelid defect in felines
What is the technique used to treat Eyelid Agenesis?
Dziezye-Millichamp Mucocutaneous Pedicle Graft
Entropion
Inward turning of the eyelid margin
What are the clinical signs of Entropion?
Asymptomatic Ocular discharge Epiphora Self trauma Corneal erosion ulceration visual deficits
What are the characteristics for Congenital Entropion?
Bilateral
Lower lateral lid
In what species is Entropion common?
dogs
In what age do you commonly see Entropion in dogs?
Less than 6 months
At what age do you correct Entropion in dogs?
after 8 months of age
What are the predisposing factors of Entropion?
Size of the globe
Globe position in orbit
Length of palpebral fissure
Tone of orbicularis m.
What are the breeds that are predisposed to Entropion?
Chow Chow
Shar-Pei
Saint Bernard
What is the Acquired Form of Entropion associated with?
Lid Spasm
What are the characteristics of Acquired Entropion?
Unilateral
at any age
What are the surgical options for Entropion?
Eyelid tacking
Hotz-Celsus
Modified Hotz-Celsus
Arrowhead resection
What suture do you use for the Hotz-Celsus Technique?
5/0 PDS
What suture do you use for Eyelid Tacking?
3/0-5/0 PDS
What suture pattern is used for eyelid tacking?
Interrupted Lembert
What do you use the Modified Hotz-Celsus Procedure for?
Medial canthal entropion
Ectropion
Eversion of the eyelid
In what breeds are Ectropion congenital in?
Saint Bernard
Bloodhound
What causes Acquired Ectropion?
Contraction of scar tissue
Overcorrection of entropion
When do you treat Ectropion?
when the animal develops signs of Keratitis, Conjuncitivitis
What techniques are used for treatment of Ectropion?
Wedge Resection
V-Y Blepharoplasty
What are the clinical signs of Nasolacrimal System?
Epiphora
Periorbital alopecia and tear staining
Mucopurulent ocular discharge/conjunctivitis
What are the diagnostic tests for Nasolacrimal system?
Jones 1 Test Nasolacrimal flushing Dacryocystorhinography CT MRI
What are the disease of Nasolacrimal System?
Punctal aplasia Micropunctum Trauma and scaring KCS
What is the most commonly reported congenital anomaly of the drainage system in dogs?
Punctal aplasia and Micropunctum
What are the clinical signs of Punctal aplasia and Micropunctum?
Epiphora
Tear staining
What are the functions of the Nictitating Membrane?
Tear production
Protect globe
Removes debris from cornea
What are the surgical diseases of the Nictitating Membrane?
Everting nictitating membrane
Prolapsed nictitating membrane (cherry eye)
Neoplasia
What is the most common disorder of the 3rd eyelid?
Prolapsed Nictitating Membrane
What are the surgical options for Prolapsed Nictitating Membrane?
Orbital rim anchoring technique
Pocket technique
What solution do you use to prep for ophthalmic surgery?
0.2% Iodine solution
.05% Chlorohexadine gluconate and alternate with saline
What recumbency would you use to perform ophthalmic surgery on both eyes?
Sternal recumbency
What recumbency would you use to perform ophthalmic surgery on one eye?
Lateral recumbency
What would you use a Barraquer eyelid speculum for in ophthalmic surgery?
placed under the lower and upper lid for better examination
What would you use a Jaeger eyelid plate for in ophthalmic surgery?
between the eyelid and the globe to protect and flatten out the eyelid
What would you use a Bishop Harmon Forceps for in ophthalmic surgery?
grasp conjunctival tissue
What would you use Derf needle holders for in ophthalmic surgery?
secures smaller needles and smaller suture
What would you use Stevens tenotomy scissors for in ophthalmic surgery?
Scissors used specifically for ophthalmic procedures because they are sharp and pointed
Why do you not usually use gauze and cotton tipped swabs in ophthalmic procedures?
they shed fibers and irritate the eye
Why would you use epinephrine in ophthalmic surgery?
Use to vasconstrict bleeders
What MUST you achieve with correction of Eyelid lacerations?
proper occlusion of the commissures to reduce KCS and irritation
What two patterns do you use with eyelid lacerations?
- simple continuous
2. figure 8 pattern
Why do we use the figure 8 pattern in eyelid lacerations?
to provide anatomical alignment and bring the suture tags away from the commissure to reduce irritation
Why would you use Vicryl in the figure 8 pattern from eyelid lacerations?
it is soft and can be exposed to the cornea
Exopytic
growing outward from the skin
What is the advantage of using the H shaped resection?
preserves some of the eyelid
decreases the chance of performing eyelid reconstruction
When would you use the semi circular flap for eyelid reconstruction?
lateral defects of the upper or lower lid
What is the most common eyelid affected by agenesis?
upper lateral eyelid
What is the most common form of Entropion in dogs?
Congenital
What suture patterns would you use with the Hotz Celsus Technique Incision Method?
Simple Continuous pattern
Simple Interrupted
What is a disadvantage to using the Modified Hotz Celsus procedure?
Can cause problems with tear drainage
What is an advantage to the Modified Hotz Celsus procedure?
Can open the caniculi and improve appropriate draining and reduce tear staining
What is the common cause of Ectropion?
Congenital
What does the Dacryocystohinography test for?
Cyst or neoplasia where the lacrimal gland runs through
What is the cause of Prolapsed Nictitating Membrane?
loss of structure of the connective tissue around the gland of the third eyelid
What does Prolapsed Nictitating membrane predispose to?
KCS
Mucopurulent discharge
What are the disadvantages of enclosing the Nictitating membrane entirely?
seroma formation
When would you use a transpalpebral approach for enucleation?
Neoplasia
If 2 or more muscles are avulsed it indicates what?
you have compromised blood supply to the globe itself
How should you treat a Proptosis with alot of pain?
enucleate
