Ophthalmology Module 23: Eye and Laser Surgery

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Questions and Answers

What is a requirement for laser eye protection for staff?

Permanent labeling with the wavelength and ocular density (correct)

Storage in a shared container

Flexible side shields that can be removed

Colored lenses for improved visibility

What action should be taken immediately after using a laser in a procedure?

Leave the safety signs up permanently

Notify patients about the procedure outcomes

Inform all staff to evacuate the room

Remove laser-specific warning signs (correct)

How should laser eye protection be stored when not in use?

Left on the table for quick retrieval

In individual cases or sleeves (correct)

In a drawer with other surgical instruments

In a common area to allow easy access

Which is NOT a guideline for the environment in a controlled laser area?

Use of reflective surfaces is encouraged Signup and view all the answers

What is required of the healthcare team regarding the patient's eyes during a laser procedure?

To protect the patient's eyes during general anesthesia Signup and view all the answers

Which structures are included in the bony orbit of the eye?

Maxilla, palatine, frontal, sphenoid, zygomatic, ethmoid, and lacrimal bones Signup and view all the answers

What is the primary function of the lacrimal apparatus?

To produce and secrete tears onto the ocular surface Signup and view all the answers

Which layer lines the inside of the eyelids?

Palpebral conjunctiva Signup and view all the answers

Which of the following muscles are classified as extraocular muscles?

Superior rectus, inferior oblique, and lateral rectus Signup and view all the answers

What is the role of the aqueous humor in the eye?

To maintain intraocular pressure and provide nutrients to the avascular structures Signup and view all the answers

Which portion of the conjunctiva covers the surface of the globe?

Bulbar conjunctiva Signup and view all the answers

Where is the vitreous humor located in the eye?

Behind the lens, filling the space between the retina and lens Signup and view all the answers

What is a key consideration when performing laser surgery in the perioperative setting?

Following strict protocols as outlined by ORNAC for laser safety Signup and view all the answers

What is the primary function of phenylephrine in ophthalmic procedures?

Permitting focusing Signup and view all the answers

Which agent is commonly used to inhibit focusing during eye surgeries?

Atropine Signup and view all the answers

What is the purpose of using constricting drops in anterior segment surgeries?

To constrict the pupils Signup and view all the answers

Which substance is primarily used to keep the cornea moist during surgery?

Balanced Salt Solution (BSS) Signup and view all the answers

What is the safe range of epinephrine concentration when used with injectable anesthetics?

1:50,000 to 1:200,000 Signup and view all the answers

Which agent is used topically to inhibit scar formation in glaucoma-filtering procedures?

5-Fluorouracil Signup and view all the answers

What is the main function of viscoelastics in intraocular surgeries?

To lubricate and support ocular tissues Signup and view all the answers

Which machine uses ultrasound to manage cataracts during surgery?

Phacoemulsification Machine Signup and view all the answers

Why is epinephrine sometimes added to Balanced Salt Solution (BSS) during procedures?

To prevent bleeding Signup and view all the answers

Which local anesthetic is used in varying concentrations alongside epinephrine?

Mepivacaine Signup and view all the answers

What is a potential indication of an increase in floaters in a patient's vision?

Possible retinal detachment Signup and view all the answers

Which procedure is primarily used to assist in the regression of neovascularization in diabetic retinopathy?

Laser treatment Signup and view all the answers

What is the function of pneumatic retinopexy in retinal detachment repair?

Creating a gas bubble to alleviate pressure on the retina Signup and view all the answers

During which procedure is the lens removed along with its capsule using a cryoprobe?

Intra Capsular Cataract Extraction (ICCE) Signup and view all the answers

What complication may result from bleeding of newly formed vessels in the vitreous?

Opaque vitreous affecting vision Signup and view all the answers

What is the main goal of vitrectomy surgery?

To restore patient vision and treat underlying conditions Signup and view all the answers

What technique is primarily used in cataract surgery to remove an opaque lens?

Phacoemulsification Signup and view all the answers

What is the purpose of scleral buckling in retinal surgery?

To compress the choroid and reattach the retina Signup and view all the answers

Which of the following conditions might lead a surgeon to perform a vitrectomy?

Severe opacity of the vitreous Signup and view all the answers

What does electrocoagulation in laser treatment aim to prevent in patients with diabetic retinopathy?

New vessel formation and blurred vision Signup and view all the answers

What does the 'A' in the acronym LASER stand for?

Amplification Signup and view all the answers

What characteristic of laser light allows it to maintain a narrow beam over long distances?

Collimated Signup and view all the answers

Which process describes how photons are released as laser energy?

Emission Signup and view all the answers

What is the significance of laser light being monochromatic?

It has a single wavelength or color. Signup and view all the answers

Which statement is true regarding the organization of laser waves?

They are organized and travel in phase. Signup and view all the answers

What is the primary energy source converted by lasers?

Electrical energy Signup and view all the answers

In the process of stimulated emission, what happens to the photons?

They create newer, high-energy photons. Signup and view all the answers

Which of the following correctly describes the term 'radiation' in the context of lasers?

It is the transmission of energy in the form of light waves. Signup and view all the answers

What effect does passing laser light through a lens typically achieve?

It concentrates the light onto a tiny spot. Signup and view all the answers

Study Notes

Anatomy of the Eye

The bony orbit comprises 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 apparatus.
Lacrimal glands secrete tears, which travel through ducts onto the ocular surface, maintaining corneal moisture and eliminating debris.
The eyelid consists of skin, ocular adnexa (eyelashes and glands), subcutaneous tissue, lymphatics, and muscles.
Conjunctiva is a transparent mucous membrane, with palpebral and bulbar portions lining the eyelids and globe respectively.
Eye movements are controlled by extraocular muscles: four recti (superior, inferior, medial, lateral) and two oblique muscles (superior, inferior).

Eye Medications

Phenylephrine (Neo-synephrine): Facilitates focusing.
Atropine: Inhibits focusing.
Miotics (e.g., Miochol): Constrict pupils for anterior segment surgeries.
Viscoelastics (e.g., Sodium hyaluronate): Lubricate and protect the cornea during intraocular surgeries.
Balanced Salt Solution (BSS): Keeps the cornea moist and may include epinephrine to reduce bleeding.
Hyperosmotic Agents (e.g., Mannitol): Lower intraocular pressure during surgeries.

Anesthesia and Antimetabolite Agents

Local anesthetics (e.g., Lidocaine, Bupivacaine, Mepivacaine) used with varying concentrations of epinephrine.
Hyaluronidase: Enhances anesthetic effects.
5-Fluorouracil (5-FU) and Mitomycin: Topical agents to prevent scarring in glaucoma-filtering surgeries.

Surgical Equipment

Phacoemulsification Machine: Uses ultrasound to break cataracts with irrigation and aspiration.
Posterior Vitrectomy Machine: Removes vitreous gel, crucial for patients experiencing floaters.

Surgical Procedures

Laser Treatment in Diabetic Retinopathy: Focuses on preventing new vessels from forming through photocoagulation.
Vitrectomy: Surgical removal of vitreous gel to restore vision and treat underlying conditions.
Pneumatic Retinopexy: Injection of gas bubbles to push a detached retina back onto the choroid.
Scleral Buckling: External procedure attaching retina back to its normal position using silicone.

Intraocular Surgeries

Cataract Surgery: Removal of opaque lenses with techniques like Extra Capsular Cataract Extraction (ECCE) and Intra Capsular Cataract Extraction (ICCE).

Introduction to Lasers

Laser: Acronym for "Light Amplification by Stimulated Emission of Radiation," converting energy into optical energy for precise surgical applications.
Characteristics include collimation (focused over distances), coherence (organized waves), and monochromaticity (single wavelength).

ORNAC Laser Safety Standards

Preoperative Protocol: Use checklists, direct focus on laser and surgeon when in-use, and maintain documentation.
Safety Environment: Limit access, use warning signs, maintain closed doors, and minimize reflective surfaces.
Eye Protection: Staff must wear labeled laser eyewear, inspect for damage, and have protection available at entrances.
Patient Safety: Healthcare team to ensure patient's eyes are protected during procedures, actively monitored under anesthesia.

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Description

This quiz focuses on Module 23, covering the essential aspects of ophthalmology and laser surgery. Students will learn to describe the anatomy of the eye and relevant surgical interventions. Suggested readings include Alexander's Care of the Patient in Surgery and Tighe's Instrumentation for the Operating Room.