OPHTHALMIC
INSTRUMENTS
ESSENTIAL EQUIPMENT FOR
OPHTHALMIC OPERATION THEATRE
• An operating microscope
• An ophthalmic cryo unit
• A wet field bipolar cautery
• An electrolysis machine
• An electromagnetic unit for removal of intraocular foreign body
• A vitrectomy unit
• Phacoemulcification machine
Commonly used ophthalmic instruments
• Lid speculum:
[Link] metallic eye speculum
• It is called universal eye speculum
because it can be used for both eyes i.e.,
right as well as left.
• It has 2 limbs and a spring mechanism
with a screw to adjust the limbs.
[Link] speculum with guard:
• It retracts the lid and its solid blades keep
the lashes away from field of operation.
WIRE SPECULUM:
• Uses. Eye speculums are used to keep the lids apart
during:
•Any intraocular operation such as cataract surgery
• and glaucoma surgery.
•Any extraocular surgery e.g., squint surgery, pterygium surgery.
•Enucleation and evisceration operation. Removal of
conjunctival and corneal foreign bodies.
•Cauterization of corneal ulcer. Examination of the eye in a
patient with blepharospasm.
Forceps:
Superior rectus holding forceps
It is a forcep with a double curve at the end(S shaped)
It has a single big tooth to hold the superior rectus muscle
It has it first angle at a distance of 7.7 mm
Uses-
Used to hold the superior rectus muscle for passing bridle suture
to rotate the eyeball downward in cataract and glaucoma surgery.
To fix the eyeball during surgery.
Globe Fixation Forceps
• Characteristics-
It has 2-3 or 3-4 teeth at its tip.
It is used to hold the conjunctival tissue and
episcleral tissue together.
• USES-
To hold the conjunctiva for making
conjunctival flap with use of conjunctival
scissor.
To fix the globe while making tunnel with
crescent.
Corneoscleral forceps:
• Commonly used are colibri/lims forceps
• Uses: These are used to hold
the cornea or scleral edge (of incision)
for suturing during cataract,
glaucoma,repair ofcorneal and/or
scleral tears and keratoplasty operations
Kelman-McPherson forceps
These
are fine forceps with bent limbs.
Uses: (i)To hold the
superior haptic of IOL during its
placement.
(ii)To
tear off the anterior capsular
flap in ECCE.
(iii)Can be
used for suture tying.
Iris forceps
• These are small and delicate forceps
having fine 1x2 teeth on the inner side
of the limbs. These are also available in
various shapes and designs.
• Uses:
• These are used to catch the iris for the
purpose of iridectomy during operations
for cataract, glaucoma, optical
iridectomy and excision for irisprolapse,
tumours and entangled foreign bodies
Hooks and retractors
Muscle (strabismus) hook
It is similar to the lens expressor in but has a
blunt guarding knob at the end to prevent muscle
slippage. The plane of the handle is the same as
that of the curvature of hook.
Uses:
1. It is used to engage the extraocular muscles
during surgery for squint, enucleation and
retinal detachment.
2. In the absence of lens expressor, it may be
used in its place.
Lens
expressor(hook)
• It is a flat metal handle with a rounded curve
at one end. Tip of the curve is knobbed. The
plane of the handle is at right angle to the
curvature of the hook.
• Uses:
1. To apply pressure on the limbs at the 6
O’clock position during the delivery of lens
in intracapsular cataract extraction with
Smith’s (tumbling) and capsule forceps
techniques.
2. To express the nucleus in extracapsular
cataract extraction.
3. It can also be used as muscle hook if the
latter is not available.
4.
Self-retaining lacrimal wound (Muller’s)
retractor
• It is made up of two limbs with three curved
pins on each for engaging the edges ofthe skin
incision. The limbs are kept in a retracted
position with the help of a fixing screw.
• Uses: to retract the skin during surgery on the
lacrimalsac (e.g., DCT or DCR).
Desmarre’s
retractor
• It is a saddle shaped instrument folded on
itself at one end. It is available in 2 sizes:
• small(paediatric)
• and large (adult).
• Uses:
• It is used to retract the lids during examination
of the eyeball in cases of blepharospasm in
children, in cases with marked swelling and
ecchymosis, removal of corneoscleral sutures,
removal of corneal foreign body and for double
eversion of upper lid to examine the superior
fornix.
• Advantages: Allows continuous adjustment of
the lids and width of the palpebral aperture.
NEEDLE HOLDER
• Spring action (barraquer needle holder)
• The jaws of needle holder are finely
serrated to hold the needles firmly
• Uses:passing sutures in conjunctiva,
cornea,extraocular muscles
Castroviejo calliper
• It is used to takemeasurements during squint, ptosis, retinal
detachment and pars plana vitrectomy surgery. It is
also used to measure corneal diameter and
visiblehorizontal iris diameter.
Knifes and needles
• SIDE PORT ENTRY BLADE
• straight knife with a sharp pointed tip and
cutting on one side.
• Uses.
• It is used to make a small valvular clear
corneal incision (commonly called as side port
incision) in phacoemulsification and other
intraocular surgeries including pars plana
vitrectomy.
KERATOME
Diamond-shaped blade with a sharp apex and two cutting edges
• USES
• Valvular corneal incisions for entry into the anterior chamber
for all modern techniques of cataract extraction
• self-sealing incisions for phacoemulsification and manual SICS
operation.
CRESCENT KNIFE
• blunt-tipped, bevel up knife having cut-
splitting action at the tip and both the
sides
• Uses:
• It is used to make tunnel incision in the
sclera and cornea for
phacoemulsification, manual small
incision cataract surgery (SICS), and
sutureless trabeculectomy.
Clamps
Lid clamp or entropion clamp
• Advantage over lid spatula: It is a self- retaining
instrument and does not need an assistant to hold.
• Disadvantages: (i) Operative field is less. (ii)
• Pressure necrosis can occur if fitted tightly
Uses: It is used in
lid surgery e.g., entropion, and ectropion
corrections.
• It protects the eyeball, supports the lid tissue
and
provides haemostasis during surgery.
Chalazion clamp
• It consists of twolimbs like forceps, which can
be clamped with the help of a screw. The tip of
one limb is flattened in the
form of round disc while the tip of the other arm
has a
small circular ring.
Usually the flat disc is applied on
the skin side and ring on the conjunctival side of
the
chalazion.
• Uses: To fix the chalazion and achieve
haemostasis during incision and curettage.
Additional instrument for cataract
surgery
Iris repositor
It consists of a delicate, flat, malleable,
straight or bent blade with blunt
edges and tip attached to a handle.
Uses:
1. To reposit the iris in the anterior
chamber in any intraocular surgery.
2. To break synechiae at the pupillary
margin.
Two way irrigation and aspiration cannu
It is available in various designs,
commonly used are simcoe’s
classical or reverse cannula.
Uses:
1. For irrigation and aspiration
of the lens matter in
extracapsualr cataract
extraction.
2. Aspiration of hyphaema.
Wire
vectis
It is a wire loop attached to a
metallic handle.
Uses:
It is used to remove
subluxated lens and
anteriorly dislocated lens in
ICCE technique and the
nucleus in ECCE technique.
Instrument used in IOL
implantation
IOL dialer or Sinskey hook
It is a fine but stout instrument with a bent tip.
The tip engages the dialing holes of the IOL.
Uses:
1. It is used to dial the PMMA non-foldable IOL
for proper positioning in the capsular bag or
ciliary sulcus.
2. It can also be used to manipulate the nucleus
in phacoemulsification surgery.
Nucleus manipulate may be in the form of
nucleus rotation in the capsular bag, cracking of
the nucleus and feeding of the nuclear
fragments into the phaco tip.
Lens holding forceps
• Characteristics-
It is a spring action forcep.
It have has blunt curved blades.
They dont have tooth. USES-
It is used to hold the non foldable
PMMA IOL during implantation .
CHOPPER
• Resembling sinskey hook in shape. The
• inner edge of the bent tip is cutting and
may
have different angles.
• Uses. It is used to split or chop the
nucleus into smaller pieces and also for
Nuclear manipulation in
phacoemulsification
surgery.
Instruments used in LACRIMAL SAC
SURGERIES
Lacrimal probes(Bowman’s)
These are a set of straight
metal wires of varying
thickness(size 0-8) with blunt
rounded ends and flattened
central platform.
Uses:
1. To probe nasolacrimal duct
in congential blockage.
2. To identify the lacrimal sac
during DCT and DCR
operations.
Punctum
dilator(Nettleship’s)
It has a cylindrical corrugated
metal handle with a conical
pointed tip.
Uses:
To dilate the punctum and
canaliculus during syringing,
probing, dacryocystography,
DCT and DCR procedures.
Primary and secondary trephine-
Primary trephine has a pointed tip in the middle and it is used
to mark the frontal process of maxilla and lacrimal bone .
Secondary treplhine is used to make the opening in DCR
surgery.
Citelli’s bone punch
It is used in DCR surgery during osteotomy
in increasing the opening.
• Disadvantage-
Accidental damage to mucous membrane
of nose and nasal septum can occur.
Chisel
• Characteristics-
It is a thick stout flat spoon like chisel with sharp end .
USE-
It is used to break small bones in DCR surgery during
osteotomy.
Additional intsruments
Optic nerve guide (enucleation spoon)
• It is a spoon-shaped instrument with a central
cleavage. Use: To engage the optic nerve during
enucleation.
Evisceration curette
• It consists of an oval or rounded
shallow cup with blunt margins
attached to a stout handle.
• Use:
• To curette out the
intraocular contents during
evisceration operation