Ophthalmology

Objectives Review eye anatomy and surrounding structures Understanding of Common eye surgeries Familiarity with ophthalmic surgical equipment Name the nursing considerations for the Ophthalmic surgical patient.

History Cataract removal dates back 3000 years- couching 70% blind, 30 ability to see light and movement First corneal transplant 1817- failed due to animal xenograft not successful til 1905, not common til 1950 Shattered plastic plane fragments embedded in the eyes of wwII piolots did not cause reactivity leads to plastic lens inplants

Anatomy Anterior/post

Opthalmic artery for all the parts except retina (central retinal artery/vein)

Anesthesia Sedation Topical Anesthetic drops Retrobulbar block- sensory and motor RB- insertion of needle behind globe

Common Extraocular Procedures Ptosis- Correction of drooping upper eyelid Can be done from outside or inside the eyelid Can be done for cosmetic reasons or because droopy eyes interfere with vision Corneal shield

Extraocular Procedures ctd Blepharoplasty- Removal of orbital Fat pad Super common cosmetic procedure. Orbital fat pad doesn’t go away as fast as cheek subcutaneous fat Upper lid can obstruct vision

Extraocular Procedures ctd Lacrimal duct dilation Dacryocystectomy Dacryocysorhinostomy Need drill to get through bony lacrimal crest

Extraocular Procedures ctd Corneal transplant ( keratoplasty) Partial (lamellar) or penetrating (full thickness) Cornea is avascular= less rejection than any other tissue except bone. Clouds caused, by injury, chemical burn, compiled effect of lifetimes of exposure to elements. While the eye “open” it is very vulnerable to environmental contamination, minimize time. Suture is non absorbable and may be in for up to 17 months

Intraocular Procedures Cataract Removal and replacement with intraocular lens implant https://www.youtube.com/watch?v=aohAHNYpAOs Lenses are synthetic. Phacoemulsification- breaks up lens and maintains form in the anterior chamber

Intraocular ctd Anterior Vitrectomy If the vitreous enters the anterior chamber vitrectomy becomes necessary to remove vitreous from anterior cavity. This can happen during cataract surgery when the phaco is chewing up the lens. It will suddenly become a very tense procedure (pt probably awake) Goal is to remove any vitreos in the anterior chamber and keep any anterior chamber materials from going back. Anterior vitrectomy kit- Phaco vitrector tip, viscoat

Intraocular ctd Repair detached retina Cyryotherapy or use of laser to repair the hole With the bubble you have to position your head 90%of the time for 2 freaking weeks Silicone oil has a lower success rate Scleral buckling can result in myopia (also not sure this qualifies as intraocualr)

Nursing Considerations Patients should void prior to surgery. Eye bed Awake patients getting oxygen via NRB or nasal cannula + cautery = fire risk. Check implants prior to procedure and confirm with MD Lenses should be soaked in sterile saline to protect from particles in the air Don’t touch business end of instruments IOP precautions post-op Steroids for inflammation abx drops Elderly patients have cataracts and urinary frequency/urgency. They need to hold still There are many sizes of lenses and they are size specific. Confirm with surgeon. Time is of the essence with corneal transplantation. IOP precatutions means no heavy lifting, not even coughing (no cough and deep breathe) no strenuous activity in some cases not even jarring or vibrating activity. Inflammation is a big deal, eyes swell a lot and inflammation can upset the IOP

Equipment