SASx Final Exam - Ophthalmic Flashcards
What procedure is used for large defects in the lower eyelid?
Lip to Lid Flap
- Used for large defects in lower lid
- Mucocutaneous flap made at 45 degree angle from canthi
- Diverge so wider base
- Bridging incision and suture
T/F: It may be acceptable to use scissors for making incisions in ophthalmic surgery
True
What is Dziezye Millichamp Mucocutaneous Pedicle Graft used for?
eyeild agenesis
Reconstruction technique used for eyelid agenesis
- Separate away the conjunctival tissue from the skin where the eyelid is supposed to be
- Take skin graft from lower (non-affected lid) and create bridging incision
What drug is often used to stop bleeding in eye surgery?
diluted epinephrine
1:10,000
How many layers are used to close eyelid lacerations?
Two
-
Deep layer:
- Muscle & fibrous tissue
- Bites perpendicular to eyelid
- Avoid conjunctiva
- Simple continuous pattern; absorbable suture
-
Skin
- _Figure of 8**_
- Ensures apposition
- Places knots away from cornea
- Start 4 mm from eyelid margin, exit 1 mm from margin
- 5-0 or 6-0 Vicryl
- _Figure of 8**_
Inward turning of the eyelid margin is termed:
entropion
- Clinical signs: Asymptomatic, Ocular discomfort, Epiphora, Self trauma, Corneal erosion, ulceration, and visual deficits
What procedure is used for full thickness lesions when conjunctiva is excised?
Single pedicle advancement and conjunctival graft
- Used for full thickness lesions when conjunctiva is excised
- Create conjunctival flap from opposite lid
- Perform same advancement flap
- Perform tarsorrhaphy (closing the eyelid to achieve minimal movement)
- Cut graft in 2 weeks
What procedure is used for medial canthal entropion?
Modified Hotz-Celsus Procedure
- Used for medial canthal entropion
- Isolate lacrimal puncta - once you dirupt this, you’re going to f*** up your lacrimal apparatus (almost impossible to resolve)
- Create triangle with ventral apex and suture
- May decrease epiphora in some
Approximately what percentage of proptosed eyes regain vision?
~20%
What surgical option would be most indicated to temporarily fix entropion in a patient that has not reached facial maturity?
eyelid tacking
- Patient not reached facial maturity
- May resolve some cases
- Use 3/0 – 5/0 PDS
- Multiple interrupted Lembert patterns
- Leave for 4 weeks or until of age for surgery
What is the greatest amount of eyelid you can remove and still have a primary closure?
1/3
Anything beyond that, you’ll have to perform some sort of reconstruction
Congenital entropion is usually bilateral and is more common in dogs. When would you perform surgery in these cases?
after 8 months of age
Best to wait until facial features are developed and mature
________ is the most common eyelid tumor in cats
squamous cell carcinoma (SCC)
- Associated with light skinned cats and sun exposure
- Prognosis is guarded
T/F: The surgical treatment of choice for prolapsed nictitating membrane is excision of the membrane
False
The membrane is important for tear production; Excision of the membrane can lead to KCS
What type of flap is used for tumor resection >1/3 of lid length?
single pedicle advancement flap
- Used for tumor resection >1/3 of lid length
- Make rectangular incision over mass and advance
- Create burrows triangles to prevent dog ears
What is the most common neoplasia of the nictitating membrane?
squamous cell carcinoma (SCC)
Others include hemangiosarcoma, adenocarcinoma, and fibrosarcoma
What forceps are typically used in ophthalmic surgery?
Bishop-Harmon forceps
What enucleation approach is more commonly performed for neoplasia?
transpalpebral approach
- Oppose and suture eyelid margins
- Incision 5mm around palpebral fissure
- Dissect along orbital walls for exenteration
- Do not place excessive traction on optic nerve
What are the indications for performing an enucleation?
- Painful non-visual eye
- Neoplasia and non-responsive infections
Name two surgical options for treating prolapsed nictitating membrane:
- Orbital rim anchoring technique: more technically difficult
- Pocket technique: easier to learn
What is the most common disorder of the 3rd eyelid?
Prolapsed Nictitating Membrane
- Gland flips up dorsally above leading edge
- Etiology unknown
- Cockers, Pekingese, Bulldogs, Beagles
- Ocular discharge and conjunctivitis
