1. Ophthalmology

2. 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.

3. History
Cataract removal dates back 3000 years- couching 70% blind, 30 ability to see light and movement
First corneal transplant 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

4. Anatomy
Anterior/post

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

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

8. 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

9. 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

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

11. 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

13. Intraocular Procedures
Cataract Removal and replacement with intraocular lens implant
Lenses are synthetic.
Phacoemulsification- breaks up lens and maintains form in the anterior chamber

14. 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

15. 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)

16. 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

17. Equipment