Ophthalmic Instruments

Dept. Of Ophthalmology
P. S. Medical College
Karamsad
Universal Wire Eye Speculum

⚫
⚫
Can be used in both eyes
Visualising and surgical access in
extraocular and intra ocular procedures
• Retract eyelid
• Light weighted speculum in intra
ocular procedures, transmit less
pressure to eye
• Full blades, stout and large speculum in
extra ocular surgeries and strabismus
• Smaller paediatric speculum in
examination and surgery of children

30-Dec-20 Dept. of Ophthalmology, PSMC 2

Doyen’s Towel Clip
Uses:
⚫ To hold sterile drapes and phaco
tubings in place

30-Dec-20 Dept. of Ophthalmology, PSMC 3

 Desmarres Lid Retractor
⚫ It is used for double eversion, thus permitting the examination of
⚫ In addition, the lid retractor can also be used as a blunt retractor in
superior fornix

minor surgical procedures

30-Dec-20 Dept. of Ophthalmology, PSMC 4

 Dastoor’s Superior Rectus holding forceps
Uses:
1. To hold the superior rectus
muscle while passing a bridle
suture under it
2. To stabilize the eyeball during any
operation such as cataract
surgery,glaucoma surgery,
corneal surgery, etc

30-Dec-20 Dept. of Ophthalmology, PSMC 5

Tying forceps ( Curved and Straight)
• Non toothed forceps
• Atraumatic
• Mainly used to tie fine sutures in
ECCE, ICCE, Pterigium excision with
conj. grafting, keratoplasty
• Holding delicate ocular structures
such as conjunctiva, cornea
• Used for suture removal and burying
the knots 10-0 sutures into cornea

30-Dec-20 Dept. of Ophthalmology, PSMC 6

 Lim’s Corneoscleral Forceps
Uses:
⚫ To hold the cornea or scleral edge (of incision) for suturing during
⚫ Cataract, glaucoma surgery
⚫ Repair of corneal and/or scleral tears
⚫ Keratoplastysurgery

30-Dec-20 Dept. of Ophthalmology, PSMC 7

 IOL Holding Forceps
Mac Pherson
⚫ These are fine forceps with bent
blade.

⚫
USES-

⚫
Used to hold the IOL
May be used as suture tying forceps
Another Type:

30-Dec-20 Dept. of Ophthalmology, PSMC 8

Arruga’s Capsule Forceps

⚫ The forceps feature delicate spoon shaped ends

used for cupping and extracting capsular fragments or

⚫
commonly used for removing the nuclei fragments of the lens
Previously used to hold capsule in ICCE

30-Dec-20 Dept. of Ophthalmology, PSMC 9

CASTROVIEJO’S CORNEOSCLERAL SCISSORS

• Fine curved scissors

• Cutting edges kept apart by spring
action
• Used in enlarging corneal or
corneoscleral incision in
conventional cataract surgeries ICCE
and ECCE
• Enlarge corneal incision in
keratoplasty
• Used in peritomy, cutting
conjunctiva in SICS, trabeculectomy,
enucleation , evisceration.
30-Dec-20 Dept. of Ophthalmology, PSMC 10
 Steven’s Tenotoy scissors

⚫
Uses
To separate the delicate tissues
without damaging the surrounding
area in oculoplastic operations and
squint surgery

⚫ cataract
To cut superior rectus suture in
surgery

30-Dec-20 Dept. of Ophthalmology, PSMC 11

Vanna’s Scissors
• Fine and thin scissors
• Cut sutures in suture removal
• Used to cut 10-0 sutures while
suturing the cornea and conjunctiva
• May be used for Cutting the flap of
anterior capsule of lens in cataract
surgery
• Doing pupillary shincterotomy
• Cut pupillary membranes
• In Open Sky Vitrectomy(Anterior
vitrectomy).

30-Dec-20 Dept. of Ophthalmology, PSMC 12

Enucleation scissors
Indications of Enucleation:
• Primary intraocular malignancies where
other treatment modalities are not
appropriate. The tumour is left intact
within the eye for histopathological
examination
• After severe trauma where the risk of
sympathetic ophthalmitis may outweigh
any prospect of visual recovery
• Blind painful or unsightly eyes can also be
managed by enucleation, although
evisceration is generally considered the
procedure of choice.

30-Dec-20 Dept. of Ophthalmology, PSMC 13

Artery Forceps - Curved⚫ Uses:
To catch the bleeding vessels
during operations of the lids and

⚫ lacrimal sac
To hold the skin and muscle stay

⚫ sutures
To hold small ‘pea-nut’ gauze
pellets for blunt dissection in
lacrimal sacsurgery and other

⚫ extraocular surgery
To hold gauze pieces while
packing the socket after
enucleation or exenteration

⚫ operation
Also used to crush structures in
lateral canthotomy procedure
30-Dec-20 Dept. of Ophthalmology, PSMC 14
Barrequer’s Needle Holder
• Used to grasp needles during
suturing
• Flat platform
• S shapes locking system or
without a lock
• Used for conjunctival suturing
in pterigium surgery,
trabeculectomy, conjunctival
tear repair , squint surgery
• Used to make bent 26 gauge
cystiotomes used for
capsulorrhexis inDept.
30-Dec-20 cataract
of Ophthalmology, PSMC 15
Kalt Needle Holder

Uses:
To hold heavy gauge needles(thicker

than 6- 0) in

⚫ Passing bridle suture under superior

rectus muscle
⚫ Lid surgery

⚫ Skin, muscle and corneal suturing

30-Dec-20 Dept. of Ophthalmology, PSMC 16

• Long curved instrument
• 26G/ 27G used ideally Hydro dissection canula
• Inject air to form anterior chamber
after completion of cataract surgery
• Inject balanced salt solution in
hydro dissection, hydrodelination,
hydration of ports and formation of
ports after cataract surgery
• Inject air in anterior chamber before
injection of trypan blue in staining
of anterior capsule
• Used in lacrimal sac syringing and to
deliver intracameral drugs like
antibiotics, pilocarpine , adrenaline
30-Dec-20 Dept. of Ophthalmology, PSMC 17
 Cystitome
⚫ Bent 26 G needle, at tip and at
⚫ Uses-For doing anterior
hub

capsulotomy or capsulorhexis
during cataract surgery

30-Dec-20 Dept. of Ophthalmology, PSMC 18

Iris Repositor
Uses:
1. To gently reposit the iris in the
anterior chamber in case it
prolapses out during any
intraocular surgery
2. To break synechiae at the pupillary
margin

30-Dec-20 Dept. of Ophthalmology, PSMC 19

 Muscle Hook
Uses:
⚫ It is used to engage the extraocular muscles during surgery for squint,
enucleation and retinal detachment

⚫ In the absence of lens expressor, it may be used in its place

30-Dec-20 Dept. of Ophthalmology, PSMC 20

Wire Vectis

Uses:
1. For lens delivery in SICS
2. To remove dislocated or subluxated
lens

30-Dec-20 Dept. of Ophthalmology, PSMC 21

 Keratome
• Thin diamond or spear shaped blade, sharp tip and two cutting
edges
• Available in pre sterilised disposable form
• Used to make valvular self sealing corneal incision for entry into
anterior chamber for cataract surgeries like phacoemulsification,
SICS

30-Dec-20 Dept. of Ophthalmology, PSMC 22

15 Degree Lance Tip

USES:
⚫ For making side port incision
in surgeries like SICS,

⚫
phacoemulsification
For doing paracentesis

30-Dec-20 Dept. of Ophthalmology, PSMC 23

Bard Parker Knife Handle with 11 No. Blade
Uses:
⚫ For removal of very small lesions
⚫ For making AC entry in ICCE and
conventional ECCE

⚫ For making accurate stab incisions

in chalazion surgery with the help
of a chalazion clamp along the
posterior lamellae

30-Dec-20 Dept. of Ophthalmology, PSMC 24

Bard Parker Knife 15 no. Blade
Uses:
• For making ab-externo corneo-sceral section for cataract
extraction
• For dissecting scleral flaps in retinal detachment surgery
• For skin incision in upper lid blepharoplasty
• For debridement of corneal epithelium in Fungal ulcer
• In Congenital glaucoma with hazy view prior to goniotomy to improve
visualization.
• For scraping of corneal infiltrate for microbiological examination
30-Dec-20 Dept. of Ophthalmology, PSMC 25
Chalazion Clamp ⚫ Used for holding the lid during
I & C of a chalazion and achieving
haemostasis during surgery.

⚫ solid blade externally on the skin and

the ring- shaped blade on the inner
conjunctival surface.

⚫ enclose the chalazion in the ring,

tighten the clamp

⚫ Excessive tightening lead to pressure

30-Dec-20 Dept. of Ophthalmology, PSMC necrosis. 26
Chalazion Scoop
⚫ Use
⚫ To scoop out contents of the
chalazion during incision and
curettage

30-Dec-20 Dept. of Ophthalmology, PSMC 27

Castroviejo Calliper
⚫ Stainless steel intruments with

⚫
markings from 0-20mm
To take measurements in squint,

⚫
ptosis and Lid surgery.
To measure scleral tunnel diameters
in SICS,ECCE

30-Dec-20 Dept. of Ophthalmology, PSMC 28

Bowman’s Lacrial Probe

⚫
Uses:
While checking for patency of the
lacrimal drainage system to
determine the presence of a hard

⚫
stop or soft stop

⚫
During DCR to identify sac
During dacryocystectomy to identify
the common canaliculus for
cauterization, once the sac is
removed

30-Dec-20 Dept. of Ophthalmology, PSMC 29

Nettleship Lacrimal Punctum Dilator
⚫ To dilate the punctum and
canaliculus during syringing,
probing, dacryocystography, DCT
and DCR procedures

30-Dec-20 Dept. of Ophthalmology, PSMC 30

Citelli’s Bone Punch

⚫ Useful for making Osteotomy

during DCR surgery

30-Dec-20 Dept. of Ophthalmology, PSMC 31

 Optic nerve Guard
⚫ Spoon shaped instrument with
central cleavage To engage optic
nerve during enucleation.

30-Dec-20 Dept. of Ophthalmology, PSMC 32

 Evisceration Curette or Spatula

Use:

⚫ To separate the uvea from the sclera prior to removing the intraocular
contents in evisceration

30-Dec-20 Dept. of Ophthalmology, PSMC 33

• Used for giving cryotherapy
• Technique which uses extreme cold
by an instrument to freeze and Cryo probe
destroy abnormal tissue
• Used in following conditions
⚫ Cyclocryotherapy
⚫ Retinal cryopexy
⚫ Retinopathy of prematurity
⚫ Vernal keratoconjunctivitis (giant
papillae)
⚫ Basal cell carcinoma of eyelids
⚫ Intraocular tumors like
retinoblastoma,retinal capillary
hemangioma

30-Dec-20 Dept. of Ophthalmology, PSMC 34

OVD - Ophthalmic Viscosurgical Devices

AIMS: • COHESIVENESS=high molecular

• Prevention of tissue damage weight
• Wider space of manipulation • Sodium hyaluronate
• Avoid adhesions post operatively e.g. Aurogel/healon
PROPERTIES:
• DISPERSIVENESS=low molecular weight
⚫
• Elasticity
• Viscosity HPMC- Hydroxy propyl methyl cellulose
• Pseudoplasticity e.g. Viscomet
• Cohesiveness/Dispersiveness

30-Dec-20 Dept. of Ophthalmology, PSMC 35

OVD - ctd
Uses Ideal OVD
• Cataract surgery • Ease of infusion
• Corneal surgery and penetrating • Retention under positive pressure in
keratoplasty the eye
• Glaucoma surgery • Retention during
• Ocular trauma phacoemulsification
• Posterior segment surgery • Easy removal
• Strabismus surgery • Doesn’t interfere with instruments
Complications or IOL placement
• Elevation of IOP • Protects the endothelium
• Plastic anterior uveitis • Non toxic
• Capsular distension syndrome • Doesn’t obstruct aqueous flow
• Clear

30-Dec-20 Dept. of Ophthalmology, PSMC 36

IOL- Intra Ocular Lens

⚫ Artificial lens introduced to improve the

optical power of eye

Types of Implantation
• Primary implantation
• Secondary implantation

Parts of iol
• Optic: Centralpart that focuses light on
retina
• Haptic : Loops or part that holds the
lens in place in the eye

30-Dec-20 Dept. of Ophthalmology, PSMC 37

 IOL- ctd
Different generations of IOL Multifocal V/S Monofocal IOLs

⚫ 1 – Premitive Reidly and Fyodorav

st
MONOFOCAL IOL
• Provides good vision at one distance
⚫ 7 - Multifocal IOL
To
th (typically far vision)
⚫ 8 - Latest- Accommodative, Phakik and
th • Patient requires glasses after surgery
generally
Toric , Trifocal IOLs
MULTIFOCAL IOL
• Corrects vision for near, far
• Trifocal IOL may correct intermediate
vision also (Typically needed for computer)
• May eliminate or reduce the need for
glasses
30-Dec-20 Dept. of Ophthalmology, PSMC 38
IOL materials
Optic materials Haptic materials
Non foldable rigid IOL
• Poly methyl metha acrylate • Polypropylene
Foldable IOL • PMMA
• Silicone • Acrylic
• Hydrophobic acrylic
• Hydrophilic acrylic
Rollable / ultra thin IOL
• Hydrogel

30-Dec-20 Dept. of Ophthalmology, PSMC 39

Positioning of IOL
⚫
Posterior chamber IOL Iris fixated lens
• Ciliary sulcus fixation Fixed on iris with claws
• In the bag fixation
• Scleral fixation ⚫ E.g: Daljit Singh and Worst’s iris
claw lens
Anterior chamber IOL
• Angle supported IOL
• E.g: Kelmen multiflex type IOL

30-Dec-20 Dept. of Ophthalmology, PSMC 40

Dyes in Ophthalmology
⚫
Fluorescein
preferentially stains intercellular tissues
Use
• Dry eye diagnostic test
• Identifying and monitoring corneal epithelial defects and corneal ulcers
• Applanation tonometry
• Siedel’s test
• Jones dye disappearance test to assess the lacrimal passage Patency
• I/V - FFA

30-Dec-20 Dept. of Ophthalmology, PSMC 41

Dyes in Ophthalmology
ROSE BENGAL DYE LISSAMINE GREEN
• Preferentially stains membrane- • Similar to Rose bengal, but no
damaged or devitalized cells stinging, so more comfortable
• Evaluation of herpetic corneal • Preferentially stains membrane-
epithelial dendrites damaged or devitalized cells
• Superficial punctate keratitis • Like rose bengal, localization of the
• Meibomian gland dysfunction dye to the cell nucleus has been
• Dysplastic or squamous metaplastic noted.
cells of conjunctival squamous • Has not been shown to stain healthy
neoplasms ocular surface cells.
• Stinging, burning sensation

30-Dec-20 Dept. of Ophthalmology, PSMC 42

 Trypan blue
• Used to stain the anterior capsule to enhance its visualization and facilitate
performing the anterior capsulotomy.
• Useful in cases with dense cataracts and absence of any fundal glow.

30-Dec-20 Dept. of Ophthalmology, PSMC 43

 Thank You

30-Dec-20 Dept. of Ophthalmology, PSMC 44