Before reading this section I would recommend at least skimming Review of Ocular
Diseases so that you are confident with common
pathologies before you read about how those pathologies are treated surgically.
What is a minor procedure?
A minor procedure is a simple procedure that can be perfumed with minimal risk. Many of these procedures are performed
in the clinic. Examples of minor procedures are chalazion removal, punctal plug insertion, and foreign body removal.
Incision vs Excision
An incision is cutting into tissue. While and excision is cutting tissue out.
The trick to this section is to know what each of the instruments do. In all reality physicians may vary a little in
what instruments they like to use. For this reason it is better to memorize what the different instruments do then to
memorize an exact set up. This way you will be able to pick out instrument sets that don’t make sense for a
Measure ocular structures
Delivers fluid. Think Canal
Probes aka Dilators
uses electrical pulses
Refractive surgery is used to change the shape of the cornea so that a patient can see with little or no correction. The
types of procedures are the following:
LASIK (Laser-Assisted in situ Keratomileusis)
Similar to PRK in that a laser is used to reshape the eye. It is different from PRK in that a flap is created to
access the treatment area. After the laser has reshaped the eye the flap is placed over the treatment area again.
In PRK this layer is removed and discarded.
LASEK (Laser-Assisted Sub-Epithelial Keratectomy)
Near identical to PRK, but instead of removing the flap the surgeon weakens the epithelial layer with alcohol,
folds it out of the way of the treatment area then folds it back after treatment with the laser.
PRK (Photorefractive keratectomy)
Near identical to LASEK. The corneal epithelium is removed and a laser is use to reshape the cornea.
PTK (Phototherapeutic keratectomy)
This is used to treat corneal scars.
RK (Radial Keratotomy)
Uses a diamond blade to make cuts radially around the cornea. This changes the index of refraction so that the
light focuses better on the retina. This is not as popular as it was in the past.
Note: in situ means “in living”.
The sterile field is a field that is free of microorganisms. For example, if a surgeon
if performing a cataract surgery then the sterile field would be the area immediately around the patient and
the physician from the operating area up. If an unsterile object touches a sterile object the sterile object becomes
Aseptic means without infection. Sterile techniques are to major surgeries as aseptic techniques are to minor
procedures, such as those preformed in a clinical setting. The purposed of aseptic techniques are to reduce the chance
of a wound infection. The skin is still disinfected and gloves are still worn. Minor procedures usually don’t
require a sterile gown and mask.
Nonrefractive Laser Therapy
Lasers are common in ophthalmology it is important to know what different lasers their are and for what procedures they
are used. Laser got its name from the following acronym.
L – Light
A – Amplification (by)
S – Stimulated
E – Emission (of)
R – Radiation
Lasers used in ophthalmology are either thermal lasers or photodisruptive lasers.
There are two thermal lasers
- Argon – green/blue color
- Krypton – red/yellow color
Thermal lasers are used for coagulation in surgeries such as
- Diabetic Retinopathy
- Hypertensive retinopathy
There are two photodisruptive lasers
- Yag (yttrium-aluminum-garnet) say that three times fast, infrared (can’t be seen)
- Excimer (argon–fluoride) , ultraviolet (can’t be seen)
Photodisruptive lasers are used for tissue damage in surgeries such as
- Clearing an opacified capsule
- Refractive surgeries (PRK, PTK, LASIK, LASEK)
Intraocular injections are used to treat:
- Wet macular degeneration
- Retinal vein occlusions
- Diabetic retinopathy
Before initiating an intraocular injection Iodide should be put directly on the ocular surface. The physician then
injections the medication into the eye within a few seconds. When the physician has finished the injections the sharp
must be placed in the sharps container.
The Yag (yttrium-aluminum-garnet) laser is a infrared photodisruptive laser. It is used in refractive surgeries,
iridotomy, and distorting tissue surrounding an opacified capsule.
Please review microbiology.
After an instrument is used it should be cleaned of all debris and placed in an enzymatic solution.
Three effective sterilization procedures are:
- Autocluave (a machines that creates really hot steam)
- Germicides (disinfectant)
Site identification is a way to make sure the the correct procedure is being performed on the correct eye. Site
identification includes the following
- Performing a surgical time-out – This is a pause before the surgery begins when patient information is
reviewed by staff
- Consulting the patient record- Looking to make sure that the records and the procedure about to be performed are
- Patient confirmation – This is when the physician asks the patient to confirm the procedure which is about to
All people present during a laser treatment must wear eye protection. The laser must be turned off when not in use.
Assist with Procedures
When washing hands before surgery lift hands so that the water drips from the elbows. When wearing sterile gloves
don’t touch anything that is not sterile. Many techs clasp their hands together until they need to assist with a
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