Eye Surgery

Question 1

What is the exception to using petroleum ointment to lubricate the eyes for ophthalmic surgeries?

Answer 1

Avoid for microsurgeries

Question 2

What disinfectant should you use for surgical prep?

Answer 2

Dilute iodine- not Chlorhex

Question 3

What should you rinse the eye with during surgery prep?

Answer 3

Eyewash- never water or especially not alcohol

Question 4

Define entropion

Answer 4

Inversion of the eyelid margin such that the outer skin contacts the cornea or conjunctival surface

Question 5

What is acquired entropion secondary to?

Answer 5

Spastic or cicatricial –> muscles trained to invert eyelid margin to avoid pain

Question 6

What are the clinical signs of entropion?

Answer 6

1. Pain (squinting, tearing, swelling, redness)
2. Keratitis (pigment deposition +/- ulceration)

Question 7

What breeds are predisposed to entropion and where are they normally affected?

Answer 7

Large breeds- chow chows, shar-peis, goldens, Labradors, German pointers, great Danes, st Bernard etc
- affected usually at lateral canthus

Small breed- brachycephalics (pug, shih tzu, etc) and miniature poodle
-affected usually at nasal/medial canthus

Question 8

When is temporary tacking recommended in entropion cases?

Answer 8

In young animals (puppies, lambs, kids), in high anesthetic risk patients, or in spastic patients

Question 9

What type of suture and suture pattern should be used for the temporary tacking procedure?

Answer 9

3-0 to 5-0 non-absorbable suture

simple interrupted or mattress suture

Question 10

What is the hotz-celsus procedure?

Answer 10

A permanent surgical technique to fix entropion that involves making a crescent shape incision to roll out the eyelid

Question 11

What are the 3 ways to estimate how much skin should be removed in the hotz-celsus procedure?

Answer 11

1. Using digital pressure (rule of thumb technique)
2. Grasping with forceps
3. Blood technique after initial incision is made

Question 12

What tissues are excised during the Hotz-celsus procedure?

Answer 12

A section of the lid skin and orbiculais oculi muscle

Question 13

What suture and pattern should you use for closure during Hotz-celsus?

Answer 13

4-0 to 6-0 non-absorbable suture

simple interrupted pattern 2-3 mm apart

Question 14

What are the indications for tarsorrhaphy surgery?

Answer 14

Proptosis and lagophthalmos

Question 15

Define proptosis.

Answer 15

Forward displacement of the globe and entrapment by the eyelids
-usually associated with a traumatic event

Question 16

What breeds is proptosis most common in?

Answer 16

brachycephalic breeds due to their shallow orbits

Question 17

What are two good prognostic indicators for vision in proptosis cases

Answer 17

Menace and dazzle response, consensual PLR

Question 18

When should enucleation be considered in proptosis cases?

Answer 18

1. Ruptured globe
2. Optic nerve avulsion
3. 3 or more extraocular muscles severed
4. Complete hyphema

Question 19

Describe the steps of the tarsorrhaphy procedure.

Answer 19

1. Perform lateral canthotomy
2. Roll out lid margins with forceps
3. Apply pressure on globe with the back of the scalpel blade
4. Use horizontal mattress to close (use stents to minimize pressure on the eyelids)

Question 20

What is a trick you can use if you are having difficulty replacing the globe?

Answer 20

Pre-place sutures to have more leverage on the eyelids and lift on all of the sutures while simultaneously putting pressure on the globe

Question 21

What are the two layers of closure of the lateral canthotomy during a tarosrrhaphy?

Answer 21

1. Tarsoconjunctival layer with absorbable suture (figure 8 technique for eyelid margin)
2. Non absorbable suture for the skin

Question 22

What are the long term complications that can occur after tarsorrhaphy?

Answer 22

second surgery my be needed, strabismus may occur and can be severe, lagophthalmos, KCS and blindness may occur

Question 23

What 4 structures are removed during enucleation?

Answer 23

1. Globe
2. Third eyelid and associated glands
3. Conjunctiva
4. Eyelid margins with meibomian glands

Question 24

Name some indications for enucleation

Answer 24

1. Blind, painful eyes
2. Ocular congenital defects resulting in chronic problems
3. Severe intraocular infections with significant globe destruction and source of systemic infection
4. Extensive intraocular tumors
5. Extensive intraocular inflammation which is uncontrolled –> blindness
6. Extensive trauma
7. End stage glaucoma

Question 25

What are the two approaches for enucleation

Answer 25

1. Subconjunctival 2. Transpalpebral

Question 26

In what situations is the transpalpebral enucleation surgery preferred over the subconjunctival?

Answer 26

Preferred for severe infections or large neoplasias - results in large soft tissue defect