Ophthalmic Surgery Chapter 16

Anatomy of the Eye Sensory organ of sight Sensory organ of sight Main function is to convert environmental light energy to bioelectrical energy Main function is to convert environmental light energy to bioelectrical energy Relays bioelectrical information to the brain Relays bioelectrical information to the brain

Anatomy Orbit of the eye (7 Bones) Orbit of the eye (7 Bones) Frontal, Sphenoid, Ethmoid, Maxillary, Zygomatic, Lacrimal, and Palate. Frontal, Sphenoid, Ethmoid, Maxillary, Zygomatic, Lacrimal, and Palate.

Anatomy Extrinic Muscles Extrinic Muscles Six muscles attached from the orbit bones move the eye in various directions. Six muscles attached from the orbit bones move the eye in various directions. Superior rectus Superior rectus Inferior rectus Inferior rectus Medial rectus Medial rectus Lateral rectus Lateral rectus Superior oblique Superior oblique Inferior oblique Inferior oblique

Anatomy

Anatomy Lacrimal System Lacrimal System Lacrimal gland Lacrimal gland Lacrimal canals Lacrimal canals Lacrimal sac Lacrimal sac

Anatomy Lacrimal Gland Lacrimal Gland Almond sized gland located within the upper eyelid. Almond sized gland located within the upper eyelid. Secretes tears to keep the conjunctiva and the surface of the eye moist. Secretes tears to keep the conjunctiva and the surface of the eye moist ducts exit the gland and are arranged in a row to disperse the secretion over the surface of the eye ducts exit the gland and are arranged in a row to disperse the secretion over the surface of the eye.

Anatomy Globe Globe Conjunctiva Conjunctiva Sclera and cornea Sclera and cornea Choroid Choroid Ciliary body Ciliary body Iris Iris Retina Retina Crystalline lens Crystalline lens

Anatomy Conjunctiva Conjunctiva Mucous membrane covering the eye and lining the inner surface of the eyelid. Mucous membrane covering the eye and lining the inner surface of the eyelid. Opaque and highly vascular Opaque and highly vascular

Anatomy Sclera Sclera Opaque white portion of the eye. Opaque white portion of the eye. Comprises 5/6 of the eye maintaining the form of the globe. Comprises 5/6 of the eye maintaining the form of the globe. Cornea Cornea Transparent portion of the eye. Transparent portion of the eye. Anterior 1/6 of the eye. Anterior 1/6 of the eye. Together these structures form the external tunic of the eye. Together these structures form the external tunic of the eye.

Anatomy Choroid Choroid Thin, dark brown, highly vascular membrane. Thin, dark brown, highly vascular membrane. Firmly attached to the sclera. Firmly attached to the sclera. Ciliary Body Ciliary Body Similar in structure to the choroid, but has larger blood vessels. Similar in structure to the choroid, but has larger blood vessels. Ciliary (Intrinsic) Muscle Ciliary (Intrinsic) Muscle Ring muscle Ring muscle

Anatomy Iris Iris Meaning “rainbow” it is the various colored portion of the eye. Meaning “rainbow” it is the various colored portion of the eye. Continuous with the ciliary body Continuous with the ciliary body Perforation in the center called the pupil allows for the transmission of light. Perforation in the center called the pupil allows for the transmission of light. Choroid, Ciliary Body, and the Iris make up the middle tunic of the globe. Choroid, Ciliary Body, and the Iris make up the middle tunic of the globe.

Anatomy Retina Retina Delicate nervous membrane on which images are received. Delicate nervous membrane on which images are received. Continuous with the optic nerve. Continuous with the optic nerve. Center of posterior eye is a structure known as the macula. Center of posterior eye is a structure known as the macula.

Anatomy Crystalline Lens Crystalline Lens Transparent, biconvex body situated behind the pupil, in front of the vitreous body. Transparent, biconvex body situated behind the pupil, in front of the vitreous body.

Cavities and Chambers of the Eye Anterior Cavity Anterior Cavity Lies in front of the lens Lies in front of the lens Two chambers Two chambers Anterior chamber is anterior to the iris, but posterior to the cornea Anterior chamber is anterior to the iris, but posterior to the cornea Posterior chamber is posterior to the iris, but anterior to the lens. Posterior chamber is posterior to the iris, but anterior to the lens. Filled with watery fluid called aqueous humor. Filled with watery fluid called aqueous humor.

Cavities and Chambers of the Eye Posterior Cavity Posterior Cavity Larger than the anterior cavity Larger than the anterior cavity Area posterior to the lens, suspensory ligaments, and ciliary body. Area posterior to the lens, suspensory ligaments, and ciliary body. Filled with soft gelatin substance called vitreous humor. Filled with soft gelatin substance called vitreous humor. Maintains pressure to keep eyeball from collapsing. Maintains pressure to keep eyeball from collapsing.

Anatomy of the Eye

Surgical Pathology Glaucoma Glaucoma Cataract Cataract Small/large retinal detachment Small/large retinal detachment Chalazion Chalazion Strabismus Strabismus

Ophthalmic Medications Mydriatics Mydriatics Cause pupil dilation by paralyzing the iris. Cause pupil dilation by paralyzing the iris. Atropine sulfate, Neo-Synephrine. Atropine sulfate, Neo-Synephrine. Miotics Miotics Cause the pupil to constrict. Cause the pupil to constrict. Pilocarpine HCL Pilocarpine HCL

Ophthalmic Medications Viscoelastic Agents Viscoelastic Agents Used to expand the anterior chamber during cataract surgery. Used to expand the anterior chamber during cataract surgery. Anti-inflammatory Steriods Anti-inflammatory Steriods Suppresses the inflammatory response in the eye. Suppresses the inflammatory response in the eye. Prednisolone Prednisolone

Ophthalmic Medications Lubricants Lubricants Protects the cornea from drying out when the eye is unable to close. Protects the cornea from drying out when the eye is unable to close. Local Anesthetics Local Anesthetics Tetracaine Tetracaine Retrobulbar Anesthesia Retrobulbar Anesthesia Injecting lidocaine or marcaine around the optic nerve. Injecting lidocaine or marcaine around the optic nerve.

Ophthalmic Medications BSS BSS Balanced Salt Solution Balanced Salt Solution Used during eye surgery to keep the cornea from drying out. Used during eye surgery to keep the cornea from drying out. STSR will typically irrigate. STSR will typically irrigate.

Supplies and Instruments Scleral Depressor Muscle HookCastro Viejo N/D

Supplies and Instruments Bishop Harmon Forceps Colibri Forceps

Supplies and Instruments Phaco Emulsifier Operating Microscope

Common Procedures Strabismus Correction- Recession Strabismus Correction- Recession Scleral Buckle Scleral Buckle Enuleation Enuleation Cataract extraction Cataract extraction

Common Procedures

Special Considerations Patient under local anesthesia Patient under local anesthesia Room must be quiet Room must be quiet More specialized equipment More specialized equipment Personal use instrumentation Personal use instrumentation Smaller suture and needles Smaller suture and needles Microscope Microscope Ophthalmic medications Ophthalmic medications

Ophthalmic Surgery QUESTIONS? QUESTIONS?