Chapter 16 Flashcards
Opthalmic Surgery (30 cards)
What is ophthalmic surgery?
A specialty of microsurgery dealing with the eye
What are some special things the CST will have to know when doing ophthalmic surgery?
-How to set up and run a microscope
-Be familiar w the Phacoemulsification machine
-Have fine motor skills to handle micro-instruments
-Be comfortable w looking through the microscope
What is some routine equipment for ophthalmic surgery?
-Ophthalmic stretcher w attachable wrist rest for surgeon
-Donut for head positioning
-ESU
What is a Phacoemulsifier?
Machine that uses ultrasonic energy to fragment the hard lens material which is then aspirated from the eye. Used for treatment of cataracts
What is an operating microscope?
Uses lenses to magnify the surgical site. May be draped or reusable handles can be placed on the control knobs.
What is a vitreoretinal system?
Provides light, suction, diathermy, and intraoperative access during ALL posterior chamber surgeries. Allows the control of intraocular pressure by irrigation and aspiration. Some systems include a Phaco unit, laser, gas infusion, and silicone oil injector.
What is a cryotherapy unit?
Uses localized cold temperature to seal tears and holes similar to a diatherapy unit. Nitrous oxide will pass through to the tip of the probe. Used to treat retinal detachment.
What are some routine supplies used in ophthalmic surgery?
-Prep set
-Eye or head and neck back table pack (depending on procedure)
-Weck-Cel sponges
-Lint-free microwipe sponges
-Sterile gloves
-Sterile cotton swabs
-Needles and suture material
-BSS
-27- and 30-gauge disposable needles, straight and angled
What is a round bodied suture needle used for in ophthalmic surgery?
Conjunctival closure. Comes w plain collagen and polyglactin
What is a round bodied needle with a cutting tip (taper) used for in ophthalmic surgery?
Used on the lacrimal sac and nasal mucosa. It initially cuts like a cutting needle but there is minimal trauma.
What is a reverse cutting (micropoint) needle used for in ophthalmic surgery?
Eliminates the possibility of outward tearing when suturing. Is a triangular needle with a third cutting edge on the outside of the curvature
What is a spatula micropoint needle used for in ophthalmic surgery?
Corneal and corneoscleral suturing. Is a fine needle with a thin, flat profile
What is a spatulated needle used for in ophthalmic surgery?
Scleral passage in strabismus correction and retinal detachment repair
Know sutures
What are some practical considerations unique to ophthalmic surgery?
-Talking and movement should be minimized since pt is often awake.
-Nonpowdered gloves should be used
-Keep lint off instruments and sterile field to prevent formation of post-op granuloma. (Cover draped Mayo w a clear, plastic sterile X-ray cassette cover reduces dust on instruments and reduces risk of micro-instrument damage. The clear sterile Mayo stand covers are often included in cataract and other eye surgery back table packs.
-Procedure is performed under an operating microscope; if the microscope is to be draped, care should be taken to prevent breaks in sterile technique.
-Portable microscope should be brought over the pt from the side opposite the operative eye.
What are some procedural considerations for ophthalmic surgery?
-Avoid pooling of prep in or near the eye.
-Periodically irrigate the eye w balanced salt solution (BSS) to prevent corneal drying
-Trim lashes before prep if necessary
-Every procedure on globe requires use of an adhesive-backed, clear, aperture or incisable drape. Adhesive drapes cover the patient’s head and upper body. Full or 3/4 drape can be used if additional coverage of equipment is needed. Opening drape is placed over eye and extended over pt. Secure the adhesive edges around the eye using sterile swabs rather than the fingers.
-Procedures on the eyelid or conjunctiva (chalazion, entropians, etc.) require a head drape
-Skin prep: Prep from hairline to inferior mandibular border and from the anterior auricular border to beyond the midline. Eyelid first, then lashes, brow, and skin. For intraocular cases, Betadine 5% ophthalmic solution may be instilled in the conjunctival sac. Use sterile swabs soaked in prep solution to cleanse eyelashes. Rinse with sterile water.
What may be used to provide additional hemostasis?
Local anesthesia w epi
What is the CST expected to do in ophthalmic surgeries?
Keep drill and tissues cool by irrigating the area being drilled with saline. Care should be taken that all saline and bone fragments from drilling are suctioned out of the sterile field
What are the meibomian glands?
A type of sebaceous gland that secrete sebum from their ducts into the tears. They are located on the posterior margin and embedded in the tarsal plate of each eyelid.
What is a chalazion? What is it caused from? What is it characterized by?
A small lump on the inner or outer surface of the eyelid. Caused by an inflammatory reaction to material trapped inside a meibomian gland. A red, swollen area of the eyelid often characterizes chalazion
What incisions may be used for the repair of a chalazion?
Transcutaneous (outside of the eyelid) or transconjunctival (through the inside of the eyelid). Depends on the major portion of the chalazion
What is the standard procedure for the repair of a chalazion? (transconjunctival approach)
- Affected eyelid is everted w a chalazion clamp
- Incision is made on inner surface w #11 or #15 blade.
- Orbicularis muscle is incised to expose the meibomian gland.
- Gland is incised and lesion is curetted.
- Bleeding is controlled by cautery.
6.The wound is left open for drainage or approximated. - An eye pad is applied
What wound classification is the repair of a chalazion?
Class II: Clean-Contaminated
What are the layers of the eyelid?
-Skin
-Subcutaneous
-Orbicularis Muscle
-Tarsal Plates
-Palpebral Conjunctiva
