Eye Surgery & Lasers PDF

Eye Surgery & Lasers  Learning Outcomes ▪ Describe the anatomy of the eye. ▪ Explain relevant surgical interventions and procedural considerations for ophthalmology surgery. ▪ Understand the importance of eye medication instillation ▪ Distinguish between intra ocular surgery and ex...

Eye Surgery & Lasers  Learning Outcomes ▪ Describe the anatomy of the eye. ▪ Explain relevant surgical interventions and procedural considerations for ophthalmology surgery. ▪ Understand the importance of eye medication instillation ▪ Distinguish between intra ocular surgery and extra ocular surgeries. ▪ Understand the protocol according to ORNAC for laser safety in the Perioperative setting.  Introduction ▪ More than 160 million people globally have significant vision loss ▪ More than 37 million people are completely blind ▪ Sick or diseased eyes often look normal and certain diseases exhibit no warning signs ▪ Early detection of eye disease through regular eye exams can provide the most effective treatment and preserve vision Surgical Anatomy  Supporting Structure ▪ Bony Orbit ▪ Lacrimal apparatus ▪ Eyelids ▪ Muscles ▪ Globe ▪ Nerve and blood supply  Surgical Anatomy Refractive Apparatus – Cornea – Lens – Vitreous Body (Vitreous Humour) – Anterior Chamber (Aqueous Humour  Physiology of Vision ▪ Light rays transmit to the eye ▪ Iris controls the intensity of the light ▪ Light passes through: – Cornea – Aqueous fluid – Lens – Vitreous fluid ▪ Nerve endings of the retina pass the images to the optic nerve ▪ Occipital area interprets the image  Eye Anesthesia ▪ General Anesthesia ▪ Local Anesthesia – Topical (eyedrops) – Infiltration ▪ Regional Anesthesia – Peribulbar Block – Retrobulbar Block Retrobulbar Block  Ophthalmic Pharmacology ▪ Mydriatics - Dilate pupil (permit focusing) ▪ Cycloplegics - Dilate pupil (inhibit focusing ▪ Miotics - Constrict pupil ▪ Viscoelastics - Lubricate and support ▪ Viscoadherents – Maintain chamber ▪ Irrigants – Lubricate and provide moisture ▪ Hyperosmotics – Decrease intraocular pressure ▪ Antimetabolite – Inhibits scar formation Instrumentation  Perioperative Nursing Considerations Draping ▪ Water repellent ▪ Eliminating lint and fiber particles ▪ Adequate air exchange Prepping ▪ 5% Povidone Iodine ▪ Sterile Normal Saline  Perioperative Nursing Considerations Equipment ▪ Phacoemulsification and posterior vitrectomy machines ▪ Cryotherapy machine ▪ Lasers and ESU ▪ Operating microscope  Perioperative Nursing Considerations Ophthalmic Sutures ▪ Non Absorbable ▪ Fine size from 4-0 to 10-0 Nylon ▪ Delicate – Avoid handling to minimize weakening and fraying ▪ Blinking of the eye removes sutures  Extra Ocular Surgery Strabismus Surgery - Repair of any ocular misalignment ▪ Recession – Weakening procedure ▪ Resection – Strengthening procedure  Extra Ocular Surgery Dacryocystorhinostomy Removal of Chalazion  Retinal Surgery Vitrectomy ▪ Urgent - loss vitreous will cause blindness ▪ Done for both anterior and posterior chambers ▪ Anterior – Removal of front portion of vitreous tissue ▪ Posterior – Detached retina, retained foreign bodies, I/O trauma  Retinal Surgery ▪ Laser Treatment – Treatment for diabetic retinopathy ▪ Scleral buckling – Treatment of retinal detachment – A piece of silicone plastic or sponge is sewn onto the sclera at the site of a retinal tear ▪ Retinopexy – Intraocular injection of bubble of air or gas in post chamber  Intra Ocular Surgery Cataract Surgery (Surgery on Lens) - Cataract extraction is the removal of the opaque lens from the interior of the eye. ▪ Extra Capsular Cataract Extraction (ECCE) ▪ Intra Capsular Cataract Extraction (ICCE) Laser in Perioperative Setting  Laser ▪ Light ▪ Amplification by ▪ Stimulated ▪ Emission of ▪ Radiation  Characteristics Laser Light ▪ Collimated ▪ Coherent ▪ Monochromatic ▪ Laser Power  Types of Lasers ▪ CO2 Laser ▪ YAG Laser/Holmium ▪ Green Light KTP Laser  Types of Lasers YAG Laser  Types of Lasers Holmium Laser  Types of Lasers Green Light KTP Laser Types of Laser  Safety Classification ▪ Class I - Inherently safe ▪ Class II - Safe during normal use ▪ Class III - Up to 5 mW and involve a small risk of eye damage within the time of the blink reflex. ▪ Class IIIb/3B - Can cause immediate severe eye damage upon exposure. ▪ Class IV/4 – Reflected or scattered light can cause eye or skin damage  ORNAC Laser Safety Standards ▪ Nurse Laser Operator – Use of safety checklist, dedicated laser nurse, documentation ▪ Environmental – Warning signs, eye protection, restrict traffic to authorized personnel, doors remain closed, window coverings, fire extinguisher, reduce reflective surfaces ▪ Eye Protection – Appropriate eye wear to be worn by all staff  ORNAC Laser Safety Standards ▪ Patient – Protect patient’s eyes during procedure ▪ Fire Safety – Annual staff training – Basin & green towels available ▪ Instruments – Regular inspection and dull finishing ▪ Surgical Smoke – Use of laser masks or N95  References ▪ Rothrock, J. (2022). Alexander’s Care of the Patient in Surgery (17th ed.) Mosby Elsevier ▪ Tighe, S. (2015). Instrumentation for the Operating Room (9th ed.) Mosby ▪ ORNAC Standard 2023