Ophthalmic Surgery

Question 1

Which solutions cannot be used on the eye?

Answer 1

alcohol and detergents

Question 2

Which solution can be used to prep the eye for surgery?

Answer 2

1:50 (2%) iodine/saline solution

Question 3

How many layers are closed in eyelid laceration repair?

Answer 3

2 layers

- deep and skin

Question 4

How is the deep layer closed in eyelid laceration repair?

Answer 4

• bites perpendicular to eyelid

- simple continuous

Question 5

How is the skin closed in eyelid laceration repair?

Answer 5

• start 4mm from eyelid margin, exit 1 mm from margin
• figure of 8 suture pattern
• 5/0 or 6/0 Vicryl

Question 6

How much of the eyelid margin must a mass take up to be surgically removed?

Answer 6

over 1/3

Question 7

What is the most common tumor or the eyelid in dogs?

Answer 7

Meibomian gland adenoma

Question 8

What percentage of canine eyelid tumors are benign?

Answer 8

73%

Question 9

How is an eyelid tumor removed?

Answer 9

H-shaped resection

Question 10

What procedures can be done for eyelid resection, after a tumor has been removed?

Answer 10

• single pedicle advancement flap
• lip to lid flap
• single pedicle advancement flap with conjunctival graft
• semi-circular flap

Question 11

When should the lip to lid flap technique be used for eyelid resection?

Answer 11

for defects of the lower lid

Question 12

When should the single pedicle advancement flap with conjunctival graft technique be used for eyelid resection?

Answer 12

for full-thickness defects

Question 13

When should the semi-circular flap technique be used for eyelid resection?

Answer 13

defect in the lateral commisure or upper lid area

Question 14

What is the most common eyelid tumor of the cat?

Answer 14

squamous cell carcinoma

Question 15

What is eyelid angenesis?

Answer 15

• failure of eyelid to form

- skin attached directly to the globe

Question 16

What is entropion?

Answer 16

inward turning of the eyelid

Question 17

What are the clinical signs of entropion?

Answer 17

• ocular discomfort and self trauma
• epiphora
  corneal erosion, ulceration, and visual defects

Question 18

Describe the congenital form of entropion

Answer 18

• usually bilateral
• lower lateral lid more common
• patients < 6 months

Question 19

What is the cause of the acquired form of entropion?

Answer 19

associated with lid spasm due to:

• corneal ulcers
• KCS
• foreign body

Question 20

What are the surgical options to treat entropion?

Answer 20

• eyelid tacking
• Hotz celsus
• Modified Hotz celsus
• Arrowhead resection

Question 21

Describe the Hotz Celsus Hemostat technique

Answer 21

• cutting out a piece of skin to cause eversion of eyelid

- grasp skin with hemostat and leave on for 30 seconds

Question 22

Describe the Hotz Celsus Incision method

Answer 22

• make crescent shaped incision 2 mm from margin
• cut out the amount of tissue based on entropion severity
• suture incision line

Question 23

When should the Modified Hotz Celsus procedure be used?

Answer 23

medial canthal entropion

Question 24

When should the arrowhead resection be used?

Answer 24

upper and lower lateral canthal entropion

Question 25

What is ectropion?

Answer 25

eversion of the eyelid

Question 26

How is ectropion treated?

Answer 26

- no treatment needed unless clinical signs present - wedge resection - V-Y blepharoplasty

Question 27

What are common diseases of the nasolacrimal system?

Answer 27

- puntal aplasia - micropunctum - trauma and scarring - KCS

Question 28

What are the clinical signs of nasolacrimal disease?

Answer 28

- epiphora - periorbital alopecia and tear staining - conjunctivitis

Question 29

Which tests are used to diagnose nasolacrimal diseases?

Answer 29

- Jones 1 test (eye stain) - Nasolacrimal flushing - Dacrypcystorhinography (dye)

Question 30

How is punctal aplasia treated?

Answer 30

- inject saline into normal puncta - located bubble forming in occluded puncta - nip off the occluded membrane

Question 31

How is micropunctum treated?

Answer 31

- with tips or iris scissors, widen the orifice of the puncta

Question 32

How is nasolacrimal trauma diagnosed and treated?

Answer 32

- inject air into puncta and look for bubbles | - cannulate both side of laceration and leave for 3 weeks

Question 33

What are the functions of the nictitating membrane?

Answer 33

- tear production - protect globe - remove debris from cornea

Question 34

What is everting nictitating membrane and how is it treated?

Answer 34

- eversion of cartilage | - surgical excision

Question 35

What is prolapsed nictitating membrane?

Answer 35

- gland flips up dorsally above leading edge | - most common disorder of 3rd eyelid

Question 36

What are the surgical options for cherry eye?

Answer 36

- excision of membrane (not recommended) - orbital rim anchoring technique - Morgan pocket technique

Question 37

Describe the orbital rim anchoring technique

Answer 37

- small incision in anterior conjunctiva - pass 4/0 suture through hole and engage periosteum - continue purse string around the gland and tie

Question 38

What is the most common neoplasia of the nictitating membrane?

Answer 38

squamous cell carcinoma

Question 39

Describe the subconjunctival approach of enucleation

Answer 39

- lateral canthotomy first - excise 5mm eyelid margins and 3rd eyelid - transect extraocular muscles at level of globe - retract eye out of orbit - ligate and sever optic nerve

Question 40

Describe the subconjunctival approach of enucleation

Answer 40

- suture eyelids together - incision 5mm around palpebral fissure - transect extraocular muscle along orbital rim - remove all ocular tissue

Question 41

What is traumatic proptosis?

Answer 41

sudden blow to orbit which increases IOP | - eyelid entraps posterior to globe

Question 42

When should a proptosis be enucleated?

Answer 42

- if 2 or more rectus muscles are avulsed | - if the globe is ruptured

Question 43

How is proptosis treated?

Answer 43

manual reduction using eyelid sutures or lateral canthotomy | - then temporary tarsorrhaphy