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Surg Tech 104 > Surg 104--Chapter 26 > Flashcards

Surg 104--Chapter 26 Flashcards

1
Q

What is the goal of ophthalmic surgery?

A

To restore vision lost as a result of disease, injury, or congenital defect.

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2
Q

How many separate bones come together to form the orbit?

A

7

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3
Q

What are the bones that form the orbit?

A
  1. frontal
  2. lacrimal
  3. sphenoid
  4. ethmoid
  5. maxillary
  6. zygomatic
  7. palatine
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4
Q

How does the optic nerve enter the posterior orbital cavity?

A

Through the optic foramen.

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5
Q

What does the term palpebral refer to?

A

eyelids

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6
Q

Located along the lid margin and in the lacrimal carnucle, what secretes a waxy oil that seals the eyelids when they are closed?

A

sebaceous glands

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7
Q

What are the two spaces of the anterior cavity of the globe?

A

The anterior chamber and the posterior chamber.

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8
Q

What are the six muscles of the eye?

A
  1. Superior rectus
  2. Inferior rectus
  3. Lateral rectus
  4. Medial rectus
  5. Superior oblique
  6. Inferior oblique
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9
Q

What is a thin, transparent mucous membrane that lines each eyelid and covers the sclera?

A

conjunctiva

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10
Q

What is a clear tissue layer overlying the front of the eyeball?

A

cornea

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11
Q

Light enter the eyeball through the _____ and is refracted (bent).

A

cornea

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12
Q

The cornea and sclera come together at the _____.

A

limbus

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13
Q

During cataract surgery, where is the initial incision made?

A

In the limbus.

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14
Q

A thick, white, fibrous tissue that encloses about three fourths of the eyeball and acts as the external supporting layer.

A

sclera

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15
Q

Highly vascular, pigmented layer that lies directly behind the sclera. The primary function is to prevent reflection of light within the eyeball.

A

choroid layer

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16
Q

An extension of the choroid layer, located at the periphery of the anterior choroid; composed of smooth muscle to which suspensory ligaments are attached.

A

ciliary body

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17
Q

Pigmented membrane composed mainly of muscle tissue that surrounds the pupil.

A

iris

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18
Q

Innermost layer of the posterior globe; the photo-receptive layer of the eye.

A

retina

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19
Q

Receives and transmits images to the brain via the optic nerve.

A

retina

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20
Q

Two types of photo-receptive cells:

A
  1. transmit black and white

2. enable color perception

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21
Q

Distinct area of acute vision that lies near the optic nerve.

A

macula

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22
Q

What is the center of the macula?

A

fovea centralis

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23
Q

A clear, biconcave disk contained in a transparent capsule; lies directly behind the iris in the anterior chamber.

A

lens

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24
Q

What ligaments hold the lens in place?

A

zonules

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25
Q

The anterior pace of the eye is divided into two separate chambers by the _____ and the _____.

A

lens and the iris

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26
Q

The anterior space in front of the lens and iris is called the _____.

A

anterior chamber

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27
Q

Immediately behind the lens and iris is another space called the _____.

A

posterior chamber

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28
Q

A clear fluid produced by the ciliary epithelium, called the _____, fills the anterior chamber.

A

aqueous humor

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29
Q

The _____ lies between the posterior lens and the retina.

A

posterior chamber

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30
Q

The posterior chamber is filled with _____.

A

vitreous humor

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31
Q

A gel-like substance that fills the posterior chamber and nourishes the inner tissue layers.

A

vitreous humor

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32
Q

Gives shape to the posterior globe and acts as a refractive medium for light.

A

vitreous humor

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33
Q

What produces tears?

A

lacrimal apparatus

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34
Q

The lacrimal ducts extend from the _____ to the _____.

A

inner canthus to the lacrimal sac

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35
Q

The opening of each lacrimal duct is called the _____.

A

lacrimal punctum

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36
Q

Tears are composed of many chemicals including:

A
  • proteins
  • mucus
  • sodium chloride
  • glucose
  • enzymes
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37
Q

Capable of breaking down the cell membrane of bacteria.

A

tears

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38
Q

The bending of light rays through a transparent medium.

A

refraction

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39
Q

The light rays are refracted as they pass through the _____, _____, _____, and _____, and the rays converge at the focal point.

A

cornea, aqueous humor, lens, and vitreous

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40
Q

A complex process in which the lens continually changes shape to keep the image focused on the fovea.

A

accommodation

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41
Q

Used to examine the anterior chamber of the eye?

A

slit lamp

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42
Q

Used to stain the cornea and highlight irregularities of the epithelial surface.

A

fluorescein

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43
Q

Used to measure intraocular pressure.

A

tonometer

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44
Q

Direct examination of the eyes is performed with an _____.

A

ophthalmoscope

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45
Q

Used extensively in the diagnosis and evaluation of retinal and choroid diseases.

A

fluorescein angiography

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46
Q

Used to measure the density of eye tissues and detect abnormalities.

A

Ophthalmic ultrasonography

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47
Q

Produces and image of the target tissue that shows as a series of spots, the brightness of which corresponds to tissue density.

A

B-scan ultrasound

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48
Q

Depicts tissue density as amplitude on two axes.

A

A-scan ultrasound

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49
Q

During a fluorescein angiography fluorescein dye is injected _____.

A

intravenously

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50
Q
  • An opaque lens.
  • Aging is the most common cause.
  • Other factors may include genetics, trauma, toxins, systemic disease, and certain medications.
A

cataract

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51
Q
  • Inversion of the eyelid that occurs in the lower lid.

- Causes the eyelashes to rub on the cornea.

A

entropian

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52
Q

-Drooping or eversion of the lid.

A

ectropian

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53
Q
  • A disease characterized by optic nerve and visual field damage.
  • Usually caused by inadequate drainage of aqueous humor.
  • Unrelieved pressure damages the optic nerve and may result in progressive blindness.
A

glaucoma

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54
Q
  • Degeneration of the rod and cone photo-receptor cells of the retina
  • Results in central vision blindness
A

macular degeneration

55
Q

Most common cause of blindness in people over age 65

A

Age-related macular degeneration

56
Q
  • A separation or tear that allows vitreous to seep between the layers and delaminate them
  • Results of trauma of shrinking of the vitreous, which normally occurs with age
A

retinal detachment

57
Q
  • The inability to coordinate the extraocular muscles, which prevents binocular vision
  • Caused by weakness or paralysis of the muscles
  • May be congenital or acquired
A

strabismus

58
Q

Anxiety can result in increased _____ and _____.

A

hemorrhage and intraocular pressure

59
Q

True or False: The ST shares responsibility for errors in lens implants.

A

True

60
Q

IO implants must be verified _____.

A

before insertion

61
Q

Lens implants are treated in much the same way as a drug distributed _____.

A

to the field

62
Q

Ophthalmic surgery is performed with the patient in the _____ with the head stabilized on a circular headrest (doughnut)

A

supine position

63
Q

Shifting the patient immediately after surgery may result in increased _____ and _____.

A

IOP and eye injury

64
Q

Antiseptics used for eye prep include _____ (5% or as directed by the surgeon) and _____.

A

dilute povidone-iodine and hexachlorophene

65
Q

The prep area includes:

A
  • eyelid and margins
  • inner and outer canthus
  • brows
  • face (ending usually at the chin)
66
Q

What is used to irrigate the eye before the skin prep.

A

BSS or a mild antiseptic of the surgeons shoice

67
Q

Where is the skin prep started?

A

eyelid

68
Q

True or False: The canthus is considered a contaminated area.

A

True

69
Q

Most ophthalmic surgery is performed using a anesthetic with monitored sedation.

A

regional

70
Q

Pediatric patients receive a _____ anesthetic.

A

general

71
Q

Drugs that dilate the pupil but permit focusing.

A

mydriatics

72
Q

Drug used for objective examination of the retina, testing of refraction, and easier removal of lenses; may be used alone or with a cycloplegic drug.

A

Phenylephrine 2.5%, 10% (mydriatics)

73
Q

Drugs that paralyze accomodation and inhibit focusing.

A

cycloplegics

74
Q

Dilates the pupil, inhibits focusing; anticholinergic, potent, and has a long duration of action (7 to 14 days)

A

atropine 1% (cycloplegic)

75
Q

Dilates the pupil, added to bottles of balanced salt solution (BSS) for irrigation to maintain pupil dilation during cataract surgery or virectomy

A

epinephrine (1:1000) (cycloplegic)

76
Q

Potent cholinergic; constricts the pupil, used intraocularly during anterior segment surgery.

A

Carbachol (Miostat), 0.01%

77
Q

Cholinergic; rapidly constricts the pupil used intraocularly during anterior segment surgery; reconstitute immediately before using

A

Acetylcholine chloride (Miochol-E), 1%

78
Q

Topical anesthetic: onset 5-20 seconds; duration 10-20 minutes

A

Tetracaine hydrochloride (Pontocaine), 0.05%

79
Q

Injectible anesthetic: onset 4-6 minutes; duration 40-60 minutes; 120 minutes with epi

A

Lidocaine (Xylocaine), 1%, 2%, 4%

80
Q

Injectible anesthetic: onset 5-11 minutes; duration 8-12 hours with epi; often used with lidocaine for blocks

A

Bupivacaine (Marcaine, Sensorcaine), 0.25%, 0.50%, 0.75%

81
Q

Injectible anesthetic: onset 3-5 minutes; duration 2 hours (longer with epi)

A

Mepivacaine (Carbocaine), 1%, 2%

82
Q

Additives: combined with injectible local anesthetics to prolong anesthesia and reduce bleeding.

A

Epinephrine

83
Q

Lubricant and support; maintains separation between tissues to protect the endothelium and maintain the anterior chamber ; should be refrigerated; allow 30 minutes to warm to room temp.

A

Sodium hyaluronate (Healon)

84
Q

Maintains deep chamber for anterior segment procedures, protects epithelium or cornea, and improves visualization; may be used to coat intraocular lens before implantation; should be refrigerated.

A

Sodium chondroitin-sodium hyaluronate (Viscoat)

85
Q

Used to keep the cornea moist during surgery; also used as an internal irrigant in the anterior or posterior segment.

A

BSS (Endosol)

86
Q

IV osmotic diuretic; increases the osmolarity of the plasma, causing the osmotic gradient to pull free fluid from the eye into the plasma, thereby reducing the IOP

A

Mannitol (Osmitrol)

87
Q

Used topically only, never injected; used on cornea to loosen epithelium before debridement and on nasal packing to reduce congection of mucosa

A

Cocaine

88
Q

IV diagnostic aid: used in fluorescein angiography to diagnose retinal disorders

A

Fluorescein

89
Q

What are the two types of electrosurgical systems are commonly used in eye surgery?

A

The single use, battery-powered cautery and the bipolar unit

90
Q

Made of lint-free cellulose or similar material.

A

eye sponges

91
Q

True or False: The sponge is never used on the cornea.

A

True

92
Q

The sponge absorbs fluid by _____.

A

wicking

93
Q

True or False: Only lint-free miscrosurgical wipes are used on instruments.

A

True

94
Q

In _____, nodal tissue arising from a sebaceous gland is excised from the tarsal plate.

A

excision of a chalazion

95
Q

An inflammatory, benign growth that originates in a sebaceous gland of the eyelid.

A

chalazion

96
Q

A chalazion is not _____, but a granuloma develops, which can enlarge and rupture.

A

infectious

97
Q

An abnormal inversion of the lower eyelid; the goal of surgery is to restore the eyelid to correct anatomical position by resection.

A

repair of an entropian

98
Q

An inwardly turned eyelid, which causes the eyelashes to rub on the cornea. Occurs primarily in older individuals, caused by weakness and imbalance, almost always affects the lower, rather than the upper eyelids.

A

entropian

99
Q

Before repair on an entropian, the circulator instills _____ drops into the operative eye.

A

tetracaine ophthalmic

100
Q

Drooping of the lower eyelid, creates an overflow of tears and exposes the conjunctiva, which becomes dry and irritated.

A

repair of an ectropian

101
Q

Outwardly turned eyelid, most often associated with with age may also occur congenitally.

A

ectropian

102
Q

The pterygium membrane is surgically removed to prevent loss of vision.

A

excision of a pterygium

103
Q

A patch of degenerative elastic tissue that proliferates from the conjunctiva in response to chronic irritation, appears as a white or yellowish vascular mass.

A

pterygium

104
Q

The creation of a permanent opening in the tear duct for the drainage of tears.

A

Dacryocystorhinostomy

105
Q

An inflammation on the lacrimal sac, causing pain, redness, and swelling at the site of the medial canthus; appears as a red mass in the septo-orbital area.

A

dacryosystitis

106
Q

This condition arises from an obstruction or stricture of the nasolacrimal duct.

A

dacryosystitis

107
Q

Nasal sinus may be packed with gauze impregnated with a topical anesthetic.

A

dacryosystitis

108
Q

The lacrimal duct is opened and an obstruction is removed.

A

lacrimal duct probing

109
Q

What is the most common sign of abnormality of the lacrimal system?

A

constant tearing

110
Q

Performed to correct deviation of the eye caused by strabismus, affected muscles are removed and reattached to the proper location.

A

muscle resection and muscle recession

111
Q

A condition in which the eyes are unable to focus on point because the muscles lack coordination.

A

strabismus

112
Q

A portion of the muscle is excised and the severed end in reattached at the original site of insertion.

A

lateral rectus resection

113
Q

The muscle is detached from its insertion, moved posteriorly, and reattached.

A

medial rectus recession

114
Q

During muscle resection and recession traction on the muscles can cause a _____, which can result in bradycardia.

A

vagal response

115
Q

Full-thickness transplantation of a donor cornea to restore vision.

A

penetrating keratoplasty (corneal transplantation)

116
Q

What are the most common causes of corneal opacification?

A
  • Chemical and thermal burns
  • infection
  • degenerative disease
117
Q

What are the two types of corneal transplantation?

A
  • lamellar (partial penetrating) keratoplasty

- penetrating (full-thickness) keratoplasty

118
Q

Anterior chamber is not entered, about one half to two thirds of the cornea is transplanted

A

partial penetrating

119
Q

The anterior chamber is entered and a full-thickness corneal graft is transplanted.

A

penetrating technique

120
Q

During a keratoplasty, the donor tissue is placed in _____ or the surgeon’s choice or preservative and protected from contamination or injury.

A

saline

121
Q

Performed to shape the curvature of the cornea and correct a refractory problem; performed with the excimer laser.

A

LASIK

122
Q

If the anterior-posterior distance of the globe is too short, images that are close are blurred because the focal point is behind the retina; this is called _____.

A

hyperopia (farsightedness)

123
Q

If the anterior-posterior distance is too long, the focal point lies in front of the retina, resulting in blurred vision of distant objects; this is called _____.

A

myopia (nearsightedness)

124
Q

Results from an uneven curvature of the refractive medium caused by defects of the cornea, lens, or retina.

A

astigmatism

125
Q

The fragmentation of tissue by ultrasonic vibration; most common form of cataract removal.

A

Phacoemulsification (extracapsular cataract extraction)

126
Q

opacity of the lens

A

cataract

127
Q

what are the most common type of cataract?

A

age-related

128
Q

The removal of the lens only, leaving the lens capsule intact; most often performed cataract extraction.

A

extracapsular cataract extraction (ECCE)

129
Q

During prep of ECCE, several drops of _____ are instilled into the eye for antibacterial effect?

A

Betadine 10%

130
Q

Performed to remove the vitrous from the anterior chamber.

A

anterior vitrectomy

131
Q

One or more bony sections of the orbital cavity are removed to reduce pressure on the optic nerve.

A

orbital decompression

132
Q

Complete removal of the eyeball.

A

enucleation

133
Q

Procedure in which the contents of the eye are removed, but the outer shell of the sclera and the muscle attachments are left intact.

A

evisceration

134
Q

The removal of the entire eye and orbital contents, including the eyelids, ocular muscles, and orbital fat.

A

orbital exenteration

Surg Tech 104 (9 decks)

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