Ophthalmic Surgery

Question 1

How do you prepare eyelids for surgery?

Answer 1

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

Question 2

What should you avoid with surgical preparation of the eyes?

Answer 2

Avoid scrub on the cornea

Question 3

What are the basic ophthalmic intrustruments?

Answer 3

Barraquer eyelid speculum
Jaeger eyelid plate
Bishop-Harmon forceps
Derf needle holder
Stevens tenotomy scissors

Question 4

What do you do for Hemostasis of the eye?

Answer 4

Direct pressure with cotton tip applicators
Wedge shaped cellulose sponges
4x4 sponges
Hand held cautery 
Phenylephrine

Question 5

What are common surgical disease of the eyelids?

Answer 5

Eyelid lacerations
Eyelid tumors
Eyelid agenesis
Entropion 
Ectropion

Question 6

How do you manage eyelid lacerations?

Answer 6

Close in 2 layers
Deep layer: Simple continuous
Skin: Figure 8

Question 7

What is important for closing the skin of the eyelid?

Answer 7

Place knots away from cornea

Question 8

What suture should you used in closure of the skin of the eyelid?

Answer 8

5/0 or 6/0 Vicryl

Question 9

What do you do for a mass of the eyelid that is less than 1/3 the eyelid margin?

Answer 9

treat like a laceration

Question 10

What is the technique for Canine Eyelid tumor resection?

Answer 10

H shaped resection

Question 11

What are the techniques for Eyelid Reconstruction?

Answer 11

Single Pedicle advancement flap

Lip to Lid flap

Question 12

What are the most common feline eyelid tumors?

Answer 12

Squamous cell carcinoma

Question 13

Eyelid Agenesis

Answer 13

Upper lateral or lower central eyelid defect in felines

Question 14

What is the technique used to treat Eyelid Agenesis?

Answer 14

Dziezye-Millichamp Mucocutaneous Pedicle Graft

Question 15

Entropion

Answer 15

Inward turning of the eyelid margin

Question 16

What are the clinical signs of Entropion?

Answer 16

Asymptomatic 
Ocular discharge
Epiphora
Self trauma
Corneal erosion 
ulceration 
visual deficits

Question 17

What are the characteristics for Congenital Entropion?

Answer 17

Bilateral

Lower lateral lid

Question 18

In what species is Entropion common?

Answer 18

dogs

Question 19

In what age do you commonly see Entropion in dogs?

Answer 19

Less than 6 months

Question 20

At what age do you correct Entropion in dogs?

Answer 20

after 8 months of age

Question 21

What are the predisposing factors of Entropion?

Answer 21

Size of the globe
Globe position in orbit
Length of palpebral fissure
Tone of orbicularis m.

Question 22

What are the breeds that are predisposed to Entropion?

Answer 22

Chow Chow
Shar-Pei
Saint Bernard

Question 23

What is the Acquired Form of Entropion associated with?

Answer 23

Lid Spasm

Question 24

What are the characteristics of Acquired Entropion?

Answer 24

Unilateral

at any age

Question 25

What are the surgical options for Entropion?

Answer 25

Eyelid tacking Hotz-Celsus Modified Hotz-Celsus Arrowhead resection

Question 26

What suture do you use for the Hotz-Celsus Technique?

Answer 26

5/0 PDS

Question 27

What suture do you use for Eyelid Tacking?

Answer 27

3/0-5/0 PDS

Question 28

What suture pattern is used for eyelid tacking?

Answer 28

Interrupted Lembert

Question 29

What do you use the Modified Hotz-Celsus Procedure for?

Answer 29

Medial canthal entropion

Question 30

Ectropion

Answer 30

Eversion of the eyelid

Question 31

In what breeds are Ectropion congenital in?

Answer 31

Saint Bernard | Bloodhound

Question 32

What causes Acquired Ectropion?

Answer 32

Contraction of scar tissue | Overcorrection of entropion

Question 33

When do you treat Ectropion?

Answer 33

when the animal develops signs of Keratitis, Conjuncitivitis

Question 34

What techniques are used for treatment of Ectropion?

Answer 34

Wedge Resection | V-Y Blepharoplasty

Question 35

What are the clinical signs of Nasolacrimal System?

Answer 35

Epiphora Periorbital alopecia and tear staining Mucopurulent ocular discharge/conjunctivitis

Question 36

What are the diagnostic tests for Nasolacrimal system?

Answer 36

``` Jones 1 Test Nasolacrimal flushing Dacryocystorhinography CT MRI ```

Question 37

What are the disease of Nasolacrimal System?

Answer 37

``` Punctal aplasia Micropunctum Trauma and scaring KCS ```

Question 38

What is the most commonly reported congenital anomaly of the drainage system in dogs?

Answer 38

Punctal aplasia and Micropunctum

Question 39

What are the clinical signs of Punctal aplasia and Micropunctum?

Answer 39

Epiphora | Tear staining

Question 40

What are the functions of the Nictitating Membrane?

Answer 40

Tear production Protect globe Removes debris from cornea

Question 41

What are the surgical diseases of the Nictitating Membrane?

Answer 41

Everting nictitating membrane Prolapsed nictitating membrane (cherry eye) Neoplasia

Question 42

What is the most common disorder of the 3rd eyelid?

Answer 42

Prolapsed Nictitating Membrane

Question 43

What are the surgical options for Prolapsed Nictitating Membrane?

Answer 43

Orbital rim anchoring technique | Pocket technique

Question 44

What solution do you use to prep for ophthalmic surgery?

Answer 44

0.2% Iodine solution | .05% Chlorohexadine gluconate and alternate with saline

Question 45

What recumbency would you use to perform ophthalmic surgery on both eyes?

Answer 45

Sternal recumbency

Question 46

What recumbency would you use to perform ophthalmic surgery on one eye?

Answer 46

Lateral recumbency

Question 47

What would you use a Barraquer eyelid speculum for in ophthalmic surgery?

Answer 47

placed under the lower and upper lid for better examination

Question 48

What would you use a Jaeger eyelid plate for in ophthalmic surgery?

Answer 48

between the eyelid and the globe to protect and flatten out the eyelid

Question 49

What would you use a Bishop Harmon Forceps for in ophthalmic surgery?

Answer 49

grasp conjunctival tissue

Question 50

What would you use Derf needle holders for in ophthalmic surgery?

Answer 50

secures smaller needles and smaller suture

Question 51

What would you use Stevens tenotomy scissors for in ophthalmic surgery?

Answer 51

Scissors used specifically for ophthalmic procedures because they are sharp and pointed

Question 52

Why do you not usually use gauze and cotton tipped swabs in ophthalmic procedures?

Answer 52

they shed fibers and irritate the eye

Question 53

Why would you use epinephrine in ophthalmic surgery?

Answer 53

Use to vasconstrict bleeders

Question 54

What MUST you achieve with correction of Eyelid lacerations?

Answer 54

proper occlusion of the commissures to reduce KCS and irritation

Question 55

What two patterns do you use with eyelid lacerations?

Answer 55

1. simple continuous | 2. figure 8 pattern

Question 56

Why do we use the figure 8 pattern in eyelid lacerations?

Answer 56

to provide anatomical alignment and bring the suture tags away from the commissure to reduce irritation

Question 57

Why would you use Vicryl in the figure 8 pattern from eyelid lacerations?

Answer 57

it is soft and can be exposed to the cornea

Question 58

Exopytic

Answer 58

growing outward from the skin

Question 59

What is the advantage of using the H shaped resection?

Answer 59

preserves some of the eyelid | decreases the chance of performing eyelid reconstruction

Question 60

When would you use the semi circular flap for eyelid reconstruction?

Answer 60

lateral defects of the upper or lower lid

Question 61

What is the most common eyelid affected by agenesis?

Answer 61

upper lateral eyelid

Question 62

What is the most common form of Entropion in dogs?

Answer 62

Congenital

Question 63

What suture patterns would you use with the Hotz Celsus Technique Incision Method?

Answer 63

Simple Continuous pattern | Simple Interrupted

Question 64

What is a disadvantage to using the Modified Hotz Celsus procedure?

Answer 64

Can cause problems with tear drainage

Question 65

What is an advantage to the Modified Hotz Celsus procedure?

Answer 65

Can open the caniculi and improve appropriate draining and reduce tear staining

Question 66

What is the common cause of Ectropion?

Answer 66

Congenital

Question 67

What does the Dacryocystohinography test for?

Answer 67

Cyst or neoplasia where the lacrimal gland runs through

Question 68

What is the cause of Prolapsed Nictitating Membrane?

Answer 68

loss of structure of the connective tissue around the gland of the third eyelid

Question 69

What does Prolapsed Nictitating membrane predispose to?

Answer 69

KCS | Mucopurulent discharge

Question 70

What are the disadvantages of enclosing the Nictitating membrane entirely?

Answer 70

seroma formation

Question 71

When would you use a transpalpebral approach for enucleation?

Answer 71

Neoplasia

Question 72

If 2 or more muscles are avulsed it indicates what?

Answer 72

you have compromised blood supply to the globe itself

Question 73

How should you treat a Proptosis with alot of pain?

Answer 73

enucleate