Assisting in slit lamp examination (Applanation & Gonio)

Objective & Outcome Objective Outcome Learning how to assist Gonioscopy, Applanation Tonometry, Suture removal and foreign body removal Outcome To prepare and assist well for said above procedures Safe and effective maintenance of Applanation tip and Gonio lens

Indications for Gonioscopy To identify the type of glaucoma To find out abnormal deposits like PXF To look for NVA To identify angle FB, tumors of iris

Assisting in Gonioscopy evaluation Wash the hands Explain the procedure to the patient Apply local anesthetic eye drops Make the patient sit comfortably Provide coupling gel whenever required After completion of test, clean the lens with wipe or in running water Wipe dry and store Handle the lens with care as it is fragile and costly.

Goldmann Applanation Tonometry Basic aspects: Reliable and accurate measurement of IOP is possible Universally accepted as a gold – standard method Easy to perform after practicing Requires a slit lamp to measure IOP

Assisting in Applanation Tonometry Explain the procedure to the patient Make the patient comfortable Apply local anesthetic eye drops Stain both eyes with Fluourescein Wipe the excess stain Instruct the patient to look straight

Do’s and Don’t Applanation tip should be washed in running water / wipe dry Don’t use spirit to clean gonio lens and applanation tip

Assisting in Corneo- scleral suture removal (CSSR) Procedures for assisting in Corneo- scleral suture removal: Antibiotic drops should be instilled at least 4 to 5 times at 15 minute intervals prior to CSSR Clean the slit lamp Tray prepared with needle and forceps Wash and dry the hands Topical 5% providine iodine betadine eye drops to be instilled in the patient’s eye before suture removal Local anesthetic drops should be applied

Suture Removal Suture – cutting is done using 26 G disposable needle or with sterile blade. Cut sutures are pulled and removed with sterile forceps Antibiotic drops instilled after CSSR Pad and bandage is applied (Not for monocular patient) after instilling antibiotic ointment

Suture Removal All CSSR patients are advised to use antibiotic drops 4 times a day for 1 week and a to report back immediately if they develop pain and decreased vision Forceps should packed for sterilization Needles should be discarded Instruct the patient to carry out doctor’s advice

Assisting in Foreign body removal A corneal foreign body may consist of dust, iron particles, vegetable matter, or sand and mud particles Multiple or loose foreign bodies can often be removed with saline irrigation The foreign bodies can be removed with cotton – tipped applicator or with fine forceps

Procedures for assisting in foreign body removal Apply local anesthetic eye drops Encourage the patient to look straight ahead and to cooperate Once the foreign body is removed either with a needle or cotton swab, apply a drop of antibiotic eye drop Apply antibiotic ointment and cycloplegics eye drops if advised by doctor Apply a sterile pad and bandage to the eye

Questions What are the uses of Gonio? What are all the local anesthetic drops are available? What are the uses of fluorescein staining? What are the materials needed for suture removal? How will you remove the corneal foreign body?

Thank you