Cat' g paw lacrimal wound retractor
4. Cat :s paw lac rim al wou nd retr acto r (Fig. 27 .20) . It is a fork-like
ins tru n1e nt wit h the teri nin als ben t inw ard . Use: It is use d to
ret rac t the ski n dur ing lac riin al sac and lid sur ger y.
Fig . 27. 20 Cat 's paw Jacrimal wou nd retractor
t5 degree gide port
Cregeen+ knife . entry b\ade
2. Keratomes (Fig. 27 .28). A keratonie has ,a thin diaillond-
shaped blade with a sharp apex and two cutting edges.
Straight as well as curved kerato1I1es are available in
various sizes (2.8 m.m., 3 m.n1, 3.5 n1n1, 5.5 niin). Presently
disposable curved keraton1es are n1ore coillrnonly used. Use:
Keratornes are used to make valvular corneal incisions for
entry into the anterior chamber for all modern techniques
of cataract extraction viz. phacoernulsification, SICS and
even conventional ECCE and other intraocular surgeries, e.g.
iridectoinies and paracentesis.
Fig. 27 .28 Keratomes
5.15° side port entry blade (Fig. 27.31). It is a fine straight knife
with a sharp pointed tip and cutting edge on one side. Use.
It is used to make a s01all valvular clear corneal incision
(commonly called as side port incision) in phacoemulsification
and other intraocular surgeries including pars plana
vitrectomy.
Fig. 27.31 15° side port entry blade
IO. Cre sce nt kni fe (Fig. 27. 37) . It is blu nt- tip pe d, bev el up
knife hav ing cut -sp litt ing act ion at the tip an d at bo th sid es.
Its bla de is cur ved and eit her mo un ted on a pla sti c ha nd le
(di spo sab le) or can be fixed wit h me tal lic han dle . Use: It is
use d (i) To ma ke tun nel inc isio n in the scl era an d co rne a for
pha coe mu lsif ica tio n, ma nu al sm all inc isio n cat ara ct sur ger y
(SICS), an d sut ure les s tra bec ule cto my . (ii) To sep ara te the
con jun cti va an d sub con jun cti val tiss ue fro m the scl era an d
lim bu s wh en lim bal -ba sed flap is ma de for tra bec ule cto my
surgery. (iii) It can also be use d to sep ara te par tia l thi ckn ess
Iam ell ae of scl era du rin g tra bec ule cto my . (iv) To sep ara te
pte ryg ium he ad or lim bal de rm oid fro m the un de rly ing
cor nea l lam ella e. (v) To sep ara te cor nea l lam ell ae in Iam ell ar
ker ato pla sty .
~ ~ ~=e~----__llimil [Link] m,
Fig. 27. 37 Crescent knife
m [Link] rtrf
f (f
rr r rWillllrmmllilllli(
rriJrr
Optic rn~rvB guidB
(EnuclBation ~poon)
enn&uR
C E /,! E IJ T
1. Op tic ne rve gu ide (en uc lea tio ns po on ) (Fig. 27 .78 ). Iti s a sp
oo n-
sh ap ed ins tru n1 en t -with a ce ntr al cleavage. Use: To en ga ge the
,.
op tic ne rv e du rin g en uc lea tio n.
Fig. 27.78 Op tic nerve guide ([Link] sp oo n)
Two-way irrigation and
agpiration cannula
4. Two-w ay irriga tion and aspira tion cannu la (Fig. 27.55) . It
has two openi ngs, one on tip of cannu la for irriga tion and
one on anteri or surfac e for aspira tion of lens matte r or other
conte nts. At its poster ior end, there is one hub anteri or to
that of hypod ermic needl e for attach ment to IV line for
irriga tion. At the other side, there is a cannu la with a plasti c
tubin g and anoth er hub for attach ment to a syring e or other
sourc e of vacuu m for aspira tion. It is availa ble in variou s
design s, comm only used are Simco e's classi cal or revers e
cannu la. Uses: (i) For irriga tion and aspira tion of the lens
matte r in extrac apsula r catara ct extrac tion. (ii) Aspir ation
of hypha ema.
fig. 27.55 Two-way irrigation and asp, ,.ation cannul a
Bone
punch
II u,,,,e ,,11.11clz (J lg. 27. 7l). It 0onsist5 uf a stout spring handle
,111d twcJ lll;acles at clied atr1gl1ta11gle~ Tl1e ur>per blade l1as
a small hole -with a sharp cutting edge. The lower blade has
a cup-like depression. Use: It is used to enlarge the bony
opening during DCR operation by punching the bone froill
margins of the opening. Carelessness during this step can
cause accidental damage to the nasal mucosa and the nasal
septum.
.Chalazioo .
gcoop
Ii . ~ II
XII. Additional instruments for lid surgery
I. Chalazion scoop (Fig. 27.66). 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.
~ , M . , ~ ·:)]
@ 1$ trttrteftt ) ::: ~%
Fig. 27.66 Chalazion scoop