Instruments

Barraquer’s wire speculum

Barraquer’s wire speculum
• Characteristics-
▪ It is universal speculum as can be used for both
eyes.
▪ It is used to separate eye lids for intraocular
surgery.
▪ Self retaining.
▪ Light weight & causes minimal pressure on the
eyeball.
Contd...
USES-
▪ lntraocular operations such as cataract surgery, glaucoma surgery and
keratoplasty.
▪ 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.
Lims forceps

A long, thin handle with small jaws at the end

Uses
To hold the cornea or scleral edge (of incision) for
suturing during cataract surgery, glaucoma surgery,
repair of corneal and/or scleral tears.
 •
Superior rectus holding forceps
• Characteristics-
▪ It is a forceps 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
Contd...
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
Conjunctival spring scissors
• Characteristics-
▪ It may be straight or curved with sharp or
blunt tip.
▪ It is a sleek longer scissor.
▪ The blade is kept apart by spring
action.
USES-
▪ Used to cut conjunctiva to make
conjunctival flap.
 Vannas scissors
• These are very fine delicate scissors with small
cutting blades kept apart by spring action.
• The blades may be straight or curved.
Uses:
(i) These a re used for cutting anterior capsule of the lens in
extracapsular surgery and for cutting 10- 0 nylon sutures.
(ii) For cutting inner scleral flap in trabeculectomy.
(iii) For doing pupillary sphincterotomy.
(iv) For performing iridectomy.
(v) For cutting p upillary membrane.
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.
15 degrees SIDE PORTENTRY 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
Characteristics-
▪ It has a thin diamond shape blade with a sharp apex
and two cutting edge.
▪ This is a curved disposable keratome .
▪ Straight disposable keratome are also available.

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.
 Cystitome /capsulotome / 26G bent tip needle

• It is a small needle knife with a bent tip which

is sharp on both the edges.
• Presently, disposable cystotome is prepared by
bending the disposable 26 gauge or 30 gauge
hypodermic needle.
Uses:
• It is used for doing anterior capsulotomy or
capsulorhexis during extracapsular cataract
extraction.
Hydrodissection cannula
• It is a single bore 25G, 27G or 30G cannula with a 45° angulation at
about 10 co 12 mm from the free end.
• The tip at the free end can be flattened or bevelled.
Uses:
• It is used to perform hydro dissection and hydrodelineation in
phacoemulsification and manual SICS.
This cannula is attached to the syringe carrying irrigating fluid.
For hydrodissection its tip is introduced beneath the anterior capsular
margin after capsulorhexis and fluid is injected to obtain subcapsular
dissection.
Iris repositor
• It consists of a delicate, flat, malleable, straight or bent blade with
blunt edges and tip attached to a handle.
Uses:
(i) To reposit the iris in the anterior chamber in any intraocular
surgery.
(ii) To break synechiae at the pupillaiy margin.
WIRE VECTIS
• It is 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.
Simcoe’s two way irrigation and aspiration
cannula
▪ It has at one end straight or angular blunt cannula .
▪ The other end has cannula which is fixed
with the syringe.
Uses-
▪ For irrigation and suction of lens particles
or cortical matter from anterior chamber
after nuclear delivery.
▪ Can also be used for aspiration of hyphaema.
Kelman-McPherson forceps
• Characteristics-
▪ These are fine forceps
with bent blade.
USES-
▪ Used to tear off the anterior capsule of
lens in cataract surgery.
▪ Used to hold the IOL .
▪ Used to hold the sutures.
 Sinskey hook or IOL dialer
• It is a fine but stout instrument with a bent tip.
The tip engages the dialing holes of the IOL.
• Uses:
(i) It is used to dial the PMMA non-foldable lOL for
proper positioning in the capsular bag or ciliary
sulcus. (ii) It can also be used to manipulate the
nucleus in phacoemulsification surgery.
Nucleus manipulation 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.
Barraquer's Spring action needle holder
• These are available in various sizes with
straight or curved tips, in different shapes
and may be with or without locking system.
• The jaws of the needle holder are finely
serrated to hold the fine needles firmly.
Use:
• Spring type needle holders are used for
passing sutures in the conjunctiva, cornea,
sclera and extraocular muscles.
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: (i) To probe nasolacrimal duct in congenital blockage.
(ii) To identify the lacrimal sac during DCT and DCR operations
Lacrimal cannula
• It is a long curved hypodermic needle with blunt tip.
• Use: (i) For syringing the lacrimal passages.
(ii) As AC cannula for putting air, tryphan blue dye, pilocarpine and balanced salt solution in
the anterior chamber during intraocular surgery
Chalazion clamp
• It consists of two limbs like a
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.
• Use: To fix the chalazion and
achieve haemostasis during
the incision and curettage
operation.
Chalazion scoop

• It has a small cup with sharp

margins attached to a narrow
handle.
• Use: To scoop out contents of
the chalazion during incision
and curettage.
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.
Types of lenses

• Lenses are of two types: spherical and cylindrical.

1. Spherical lenses
(A) Convex lens or plus lens is a converging lens-
• Identification –
(i) Thick in the centre and thin at the periphery,
(ii)An object held close to the lens, appears
magnified,
(iii) When a convex lens is moved, the object seen
through it moves in the opposite direction to the lens.
• Uses –
• (i) for correction of hypermetropia, aphakia and
presbyopia;
• (ii) in oblique illumination (loupe and lens)
examination, in indirect ophthalmoscopy, as a
magnifying lens and in many other equipments.
(B) Concave lens or minus lens is a diverging lens
• It is of three types: biconcave, plano-concave
and convexo-concave (meniscus).
• Identification
(i) Thin at the centre and thick at the periphery.
(ii) An object seen through it appears minified.
(iii) When the lens is moved, the object seen
through it moves in the same direction as the
lens.
• Uses
(i) for correction of myopia;
(ii) as Hruby lens for fundus examination with slit-
lamp.
• Image formation - virtual, erect image of an
object.
2. Cylindrical lenses

• A cylindrical lens acts only in

one axis, i.e., power is
incorporated in one axis, the
other axis having zero power.
• A cylindrical lens may be convex
(plus) or concave (minus).
• Identification of a cylindrical lens-
1. When the cylindrical lens is rotated around its optical axis, the object
seen through it becomes distorted.
2. When it is moved up and down or sideways, the objects will move with
the lens (in concave cylinder) or opposite to the lens (in convex
cylinder) only in one direction.

• Uses of cylindrical lenses

1. Prescribed to correct astigmatism.
2. As a cross cylinder used to check the refraction subjectively.
3. Maddox rod consist of powerful convex cylindrical lenses mounted
together.
Trial frame
Trial box
Snellen’s chart
Pin hole
Occluder
Mirror retinoscopes
• Cheap and the most commonly
employed.
• A source of light is required when using
mirror retinoscope, which is kept above
and behind the head of the patient.
• A mirror retinoscope may consist of a
single plane mirror or a combination of
plane and concave mirrors (Pristley-
Smith mirror)

A, Plane mirror;
B, Pristley-Smith mirror
Self-illuminated retinoscopes
• Costly but handy.
• Two types of self-illuminated retinoscopes
available are: a spot retinoscope and a
streak retinoscope.
• The streak retinoscope is more popular.
• In it the usual circular beam of light is
modified to produce a linear streak of light
by using a planocylindrical retinoscopy
mirror.
• The streak retinoscopy is more sensitive
than spot retinoscopy in detecting
astigmatism.
Streak retinoscope
 Depending upon the movement of the red reflex when a plane mirror
retinoscope is used at a distance of 1 meter the results are interpreted as:
1. No movement of red reflex indicates myopia of 1D.
2. With movement of red reflex along the movement of the retinoscope,
indicates either emmetropia or hypermetropia or myopia of less than 1D.
3. Against movement of red reflex to the movement of the retinoscope
implies myopia of more than 1D.