Ophthalmology Surgery Procedures

Global Vision Loss Statistics

• Over 160 million people worldwide experience significant vision loss.
• Approximately 37 million individuals are completely blind.
• Many eye conditions show no obvious symptoms, making regular eye exams crucial for early detection and treatment.

Surgical Anatomy of the Eye

• Major supportive structures include the bony orbit, lacrimal apparatus, eyelids, and various eye muscles.
• The refractive apparatus comprises the cornea, lens, vitreous body, and anterior chamber.

Physiology of Vision

• Light enters the eye, passing through the cornea, aqueous fluid, lens, and vitreous fluid.
• The iris regulates light intensity, while the retina transmits image signals through the optic nerve to the occipital area for interpretation.

Eye Anesthesia Options

• General anesthesia is used for more extensive procedures.
• Local anesthesia can be administered topically via eyedrops or via infiltration.
• Regional anesthesia options include Peribulbar and Retrobulbar blocks.

Ophthalmic Pharmacology

• Mydriatics dilate the pupil to allow focusing.
• Cycloplegics dilate the pupil while inhibiting focusing ability.
• Miotics constrict the pupil, and viscoelastics lubricate and support ocular surfaces.
• Hyperosmotics help reduce intraocular pressure, and antimetabolites prevent scar formation.

Perioperative Nursing Considerations

• Surgical drapes should be water repellent and free from lint or fiber particles to maintain cleanliness.
• Preoperative prepping involves using 5% Povidone Iodine and sterile normal saline.
• Key equipment includes phacoemulsification machines, lasers, and operating microscopes.

Types of Extra Ocular Surgery

• Strabismus surgery corrects ocular misalignment using recession (weakening) or resection (strengthening) techniques.
• Dacryocystorhinostomy involves creating an opening between the tear sac and the nose.

Retinal Surgery Techniques

• Vitrectomy is an urgent procedure for removing vitreous to prevent blindness, applicable in both anterior and posterior conditions.
• Laser treatments are effective for diabetic retinopathy, while scleral buckling addresses retinal detachment using silicone implants.
• Retinopexy involves injecting a gas bubble into the posterior chamber to support reattachment.

Intraocular Surgery: Cataract Surgery

• Cataract extraction removes the cloudy lens, with two primary methods: Extra Capsular Cataract Extraction (ECCE) and Intra Capsular Cataract Extraction (ICCE).

Laser Characteristics and Types

• Lasers produce light that is collimated, coherent, and monochromatic.
• Common types of lasers used in eye surgery include CO2 lasers, YAG lasers, Holmium lasers, and Green Light KTP lasers.

Laser Safety Classifications

• Class I lasers are inherently safe; Class II lasers are safe with normal use.
• Class III lasers pose a risk of eye damage, while Class IV can cause serious damage from scattered light.

ORNAC Laser Safety Standards

• A dedicated laser nurse and safety checklist are essential during procedures.
• Eye protection must be worn by all staff, and appropriate fire safety measures should be in place, including training and equipment inspections.
• Protecting the patient’s eyes and minimizing surgical smoke exposure are critical during laser procedures.