Ophthalmology and Laser Surgery Module 23

Anatomy of the Eye

• Bony orbit consists of seven bones: maxilla, palatine, frontal, sphenoid, zygomatic, ethmoid, and lacrimal.
• The orbit houses the globe, orbital fat, extraocular muscles, nerves, blood vessels, and part of the lacrimal system.
• Lacrimal glands produce tears, which flow through ducts to the ocular surface, aiding in moisture and debris removal.
• Eyelid anatomy includes skin, ocular adnexa (eyelashes and glands), subcutaneous tissue, lymphatics, and muscles.
• Conjunctiva is a thin membrane with palpebral (inner eyelids) and bulbar (surface of the globe) portions.
• Extraocular muscles include four recti and two oblique muscles, working in pairs to control eye movements.
• The globe is filled with aqueous humor (anterior) and vitreous humor (posterior) and is cushioned by orbital fat.

Refractive Apparatus of the Eye

• The key components affecting vision include the cornea, lens, vitreous humor, and aqueous humor.

Perioperative Nursing Considerations

• Patients vary widely in age, from premature infants to elderly individuals.
• Clear communication is especially crucial for visually impaired patients during pre-operative phases.
• Patient positioning during surgery typically requires a supine position; however, this can vary based on the procedure and surgeon preferences.
• Collaboration between the perioperative nurse and surgical team promotes patient safety regarding positioning.

Instrumentation for Surgery

• Instrument types include extracapsular instruments for retinal and muscle surgeries, micro instruments for cataract surgeries, and specific tools like eye scalpels, speculum, and corneal scissors.
• Surgical procedures require a minor count of instruments—initial, closing, and final counts.

Ophthalmic Pharmacology

• Dilating drops are used pre-operatively to facilitate pupil dilation for surgeries.
• Cryotherapy and lasers are essential for treating retinal conditions and performing cataract surgeries.
• Operating microscopes provide necessary magnification and illumination during procedures.

Surgical Interventions

• Extraocular Surgeries: Address issues with the eye's muscles; common in strabismus treatment.
  • Strabismus surgery repairs ocular misalignment, categorized by types: esotropia, exotropia, hypertropia, and hypotropia.
  • Two techniques: recession (weaken the muscle) and resection (strengthen the muscle).
• Enucleation: Total eyeball removal, indicated for painful eyes, tumors, or trauma; includes an implant for prosthesis support.
• Chalazion Removal: Surgical intervention to remove meibomian gland obstructions.
• Entropion and Ectropion Repairs: Correct inverted (entropion) or sagging (ectropion) eyelids.

Retinal Surgery Procedures

• Vitreous fluid changes with age; increased floaters may indicate retinal issues.
• Laser treatment can address diabetic retinopathy by coagulating abnormal vessels.
• Vitrectomy: Removal of the vitreous gel to improve visibility and treatment of underlying conditions.
• Pneumatic retinopexy: Intraocular gas injection to support retina reattachment.
• Scleral buckling: External procedure to reattach the retina using silicone.

Intraocular Surgeries

• Cataract Surgery: Involves lens removal and replacement; methods include ECCE and ICCE.
• ECCE entails controlled rupture of the capsule while ICCE involves removing the lens within its capsule.

ORNAC Laser Safety Standards

• Follow strict protocols and maintain a controlled environment during laser procedures.
• Ensure personal protective equipment is available, including labeled laser safety eyewear.
• Maintain communication and documentation throughout the procedure to ensure safety protocol adherence.

This quiz covers key concepts from Module 23, focusing on ophthalmology and laser surgery based on Alexander's Care of the Patient in Surgery and related readings. Test your understanding of eye anatomy and surgical procedures relevant to this specialty.