This document provides information on several minor ocular procedures including ocular irrigation, trichiatic eyelash removal, corneal foreign body removal, conjunctival suturing, suture removal, chalazion incision and curettage, lid laceration repair, pterygium excision, lacrimal probing and syringing, and intravitreal injections. It describes the indications, instruments, and steps for each procedure.
2. OCULAR IRRIGATION
• In case of chemical injury, thermal
injury and multiple small particles
lodged on the cornea.
• Patient is placed in a supine position.
• pH is measured placing the strip in the
cul-de-sac.
• Double eversion of the upper eyelid is
achieved over a DESMARRES
RETRACTOR.
• Ocular surface is irrigated with NS/ RL,
every 30 mins till the pH normalizes.
3. TRICHIATIC EYELASH REMOVAL
• Misdirected eyelashes can be a
sequelae of trachoma and other
chronic inflammatory diseases of lid
margins.
• Removal can be done on an OPD
basis.
• Patient is positioned comfortably on a
slit lamp.
• Trichiatic eyelash is removed using an
EPILATION FORCEPS.
4. CORNEAL FOREIGN BODY
• A foreign body impacted and
adherent to the superficial
layers of the cornea.
• Eg: glass, wood, sand, iron
particles.
• M/c hammer and chisel injury-
iron foreign body, rust ring
forms in four to six hours from
injury.
5. • Assess the depth of the corneal foreign body and stain the cornea to r/o
any full thickness involvement.
• Instill topical anesthesia, position the patient comfortably on a slit
lamp.
• Separate the upper and lower eyelids of the patient with your fingertips.
• Using a 26-30 gauge needle and approaching tangentially to the
surface, the foreign body is engaged at the edge and loosened by
flicking movement.
• A forceps or a moist tipped cotton applicator is then used to lift off the
foreign body.
• Ocular irrigation can also be used to dislodge multiple small superficial
particles .
6. Using a 26-30
gauge needle and
approaching
tangentially to the
surface, the
foreign body is
engaged at the
edge and loosened
by flicking
movement
9. SUTURE REMOVAL
Indications: loose suture, broken suture, planned removal.
• Patient positioned comfortably on a slit lamp or OT table.
• Topical anesthesia is instilled, lids separated using wire speculum.
• Corneal sutures visualized and the light beam is focused .
• Suture loosened along the track using 26/30 gauge bent needle which is
inserted beneath the suture with the bevel facing up and is cut away from
the knot.
• KELMAN MCPHERSON’S FORCEPS is used to grab the longer end
and the suture is pulled out.
• Antibiotic drops instilled.
11. CHALAZION
• Sterile chronic granulomatous
inflammatory lesion of the meibomian
glands.
• Inspissated sebaceous secretions.
Indications of surgical intervention:
No response to oral antibiotics and
conservative management.
A large chalazion compressing the cornea
and leading to astigmatism.
13. INCISION AND CURETTAGE
• Most common modality of treatment.
• Clean and drape the eye and adnexa.
• Mark the extent of the lesion and inject anesthesia(1%-2% lidocaine with
1:100,000 epinephrine)
• Apply a chalazion clamp.
• Vertical incision approx. 3 mm in length, made on the conjunctival side
about 2-3 mm from the eyelid margin to prevent notching.
• Incision parallel to the orientation of the meibomian ducts.
• Inspissated contents curetted out.
• Sutures are not applied.
15. • Large lesions may need a
cruciate incision.
• Biopsy recurrent chalazions-
masquerade malignancy.
• Intralesional steroid injections
into larger lesions and those
proximal to lacrimal puncta
have been described.
16. LID LACERATION REPAIR
Post-trauma the lid laceration repair should be performed in 12-24 hours to
prevent subsequent complications.
Begin with copious wound irrigation to remove any foreign particles visible
on the skin.
Local subcutaneous anesthesia administered-Lidocaine 1% or 2% with
1:100,000 epinephrine
Secure the lid margin first, vertical mattress sutures placed along the
meibomian orifices to repair the posterior lamella, preferably absorbable 6-0,
7-0 vicryl.
For best wound closure approximate the edges such that slight tissue eversion
occurs.
17. LID LACERATION REPAIR
Anterior lamella is secured by placing another vertical mattress suture along
the lash follicles, or a simple interrupted suture using non-absorbable 4-0
silk suture, ends left long.
Full thickness lacerations are repaired in a multi-layered fashion as per the
correct anatomical orientation.
The tarsus and muscle layer is apposed using an absorbable 6-0, 7-0 vicryl
suture, continuous or interrupted sutures.
The skin is apposed using a non-absorbable 4-0, 6-0 silk suture, interrupted
fashion.
20. SPECIAL SITUATIONS
Canalicular injury may
necessitate the placement of
a canalicular stent before
repairing the laceration.
In case of large tissue
defects, rotational flaps and
split skin thickness grafts
may be needed.
21. PTERYGIUM
• Greek word “Pterygion” means wing.
• Elastotic degeneration of the sub-epithelial tissue
Indications for surgery:
Visual blur- astigmatism.
Increasing size and encroaching visual axis.
Significant foreign body sensation.
Cosmesis.
Atypical appearance of the lesion- excision biopsy.
23. PTERYGIUM EXCISION
• Peribulbar or topical anesthesia.
• Clean and drape the eye, adnexa, place the universal eye speculum.
• Mark the limbal extent- soft tissue dissection and excision of the pterygium.
• Level the corneal bed using a diamond burr or crescent knife.
• Bare sclera technique.
• Primary closure – high rate of recurrence.
• Rotation flaps.
• Conjunctival autograft secured with a 8-0 vicryl suture, autologous serum or
fibrin glue.
• Adjunctive therapy to reduce recurrences : application of corticosteroids,
antimetabolites like MMC, 5 FU, Thiotepa, Bevacizumab, Beta radiation.
• Amniotic membrane graft.
26. LACRIMAL PROBING AND SYRINGING
Indications:
Diagnostic to ascertain the patency of the lacrimal drainage
system.
To ascertain nature and the site of obstruction.
Therapeutic to open a partially occluded lacrimal drainage
pathway as in patients with congenital NLDO.
To irrigate the lacrimal drainage pathway to dislodge any debri
leading to decreased tear drainage.
28. PROCEDURE
• Patient is explained the
procedure.
• Topical anesthesia is instilled.
• Punctum is dilated upto 2-3 times
its diameter, using a Nettleship’s
punctum dilator.
• Probing is done using the
Bowman’s lacrimal probe and the
characteristic of the stop felt is
noted.
• Syringing is performed with a
lacrimal cannula to confirm the
patency of NLD along its length
and passage of fluid into the nose
and throat of the patient.
29. INTRAVITREAL INJECTIONS
Indications:
AntiVEGF drugs and corticosteroids are administered via the intra-vitreal
route to treat conditions like DME, VO, CNVM, PCV, posterior uveitis.
Corticosteroids can also be administered via the sub-cojunctival and sub-
tenon routes.
• Strict aseptic precautions, eye and adnexa cleaned and draped.
• Wire speculum placed, povidone iodine and topical anesthesia is instilled.
• Site marked using a Castroviejo caliper and 30 Ga needle mounted on a
tuberculin syringe used to inject the desirable dose.
