Ophthalmology

Instruments

Nikhil Gotmare,
Resident Ophthalmologist,
Guru Nanak eye centre,
Maulana Azad medical college,
New Delhi

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SPECULUMS
EYE SPECULUMS
The types are (1) universal eye speculum, (2) guarded eye speculum, (3) wire speculum.

Universal Eye Speculum

Identification: It has a spring and two limbs, and a screw to adjust the limbs.
It is called universal because it can be used on either side.
Method: It is fixed to the eyelids in such a way that screw should-
ー _
face outward and forward.
e
Uses: It is used to separate both eyelids for good exposure of the eyeball mainly during
←
extraocular operations,
ー =

e.g.
-

θ
Pterygium excision,
Squint operation
Evisceration and enucleation
Debridement and cautery of corneal ulcer
To give subconjunctival or sub-Tenon’s injection
Removal of corneal foreign body
Removal of conjunctival cyst or mass
During suture removal.

It is not used routinely in intraocular operations as it gives pressure over the globe.
This causes rise in intraocular pressure (IOP) during operation. One can put a cotton
pellet or assistant can lift the instrument during intraocular operation to avoid rise in
IOP. Otherwise, stay sutures to the lids are commonly used for intraocular operation.

Disadvantages
Since it has no guard, eyelashes of upper lid (larger) come in the field of operation.
Not used in intraocular operation because of more vitreous-upthrust and risk of
vitreous loss by direct pressure on the globe.

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PLAIN DISSECTING FORCEPS

Identification: It is an ordinary, straight forceps without any teeth at its tips. The ends
are little blunt, and on their inner surface, there are fine serrations for better grip.
Uses

←
To hold the bulbar conjunctiva during its dissection.
To hold episcleral tissue during its dissection.
It is also used during suturing of conjunctiva.
To hold conjunctiva during subconjunctival injection.
It may be used to hold small sponge swabs.

TOOTHED FORCEP

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EPILATION FORCEPS (CILIA FORCEPS)

Identification: It is a small stout forceps with blunt flat ends. Near the tip, the inner surfaces
are reinforced by extra thick platform which may be rhomboidal or elliptical
Uses

To remove the-
←
To remove the offending, misdirected eyelashes in trichiasis.
involved eyelash in stye.
No anethesia is required for epilation. It is not an ideal technique as it is not a permanent
∞
procedure. As the root is not destroyed, eyelash grows again within 6–8 weeks and
causes same irritation.
_

Ideal method should be permanent where the hair-root is destroyed.

NEEDLE HOLDING

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PIERSE HOSKIN FORCEP

Identification
Tip notched

θ
Uses
To hold delicate tissues

Advantage
Less traumatic

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FIXATION FORCEPS (EYEBALL FIXATION FORCEPS)

Identification: It is a medium-sized forcep with 2:3 teeth (may be 3:4) at its tip.

Method: The conjunctiva and episcleral tissue are firmly held at 6 o’clock position within
3–4 mm of limbus with left hand. Because, the conjunctiva is firmly adhere to episcleral
tissue and sclera around the limbus, and it is 4–5 layers thick. It may be used at other part
around the limbus (e.g. 3 o’clock, 9 o’clock, etc.).
Uses
To fix the eyeball during operative procedures, like:
Cataract surgery
Paracentasis
Pterygium surgery
Needling, etc.
To catch superior rectus muscle to pass bridle suture.
To catch other tissues, e.g. skin, Tenon’s capsule, etc.
To lift bulbar conjunctiva during subconjunctival or sub-Tenon injection.
Used in forced duction test (FDT) in case of squint to know any mechanical restriction
is present or not.
To hold the sponge piece, gauze piece or cotton ball for swabbing in depth.

BISHOP-HARMON IRIS TISSUE FORCEPS

Description:
Small, fine tissue forceps with long, thin jaws and three interlocking teeth at the tips.
Use(s):
←
Used for grasping tissue in and around the eye.

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CHALAZION CLAMP

Identification: It is a forceps with a large screw for fixing or tightening the limbs like a
clamp. One limb has got a solid disc-shaped plate and the other limb has a ring at its end.
It is hemostatic and self-retaining.

Method: The solid plate is applied on the skin surface of the lid and the ring side is applied
on the tarsal conjunctiva, encircling the chalazion. The screw is tightened and the lid
is everted and then chalazion is exposed for incision.

The functions of the screw are:

Uses
_
To fix the chalazion for surgery and also to ensure hemostasis.
To give intralesional injection of steroids in chalazion after fixing it with forceps.
Excision of a small granuloma or papilloma of the lid.

CHALAZION SCOOP (CURETTE)

Identification: It is a small scoop with sharp edge, attached to a handle. The size of the
scoop may vary. Two different sized scoops may be attached to the two ends of same
handle for convenience.

-←
Uses: To scoop out the granulation tissue after giving incision on chalazion. Scooping of the
chalazion must be complete, otherwise there may be chance of recurrence. After removal
of the chalazion forceps, the bleeding is controlled by pressure over the lid, against the
incised area. A pressure bandage is applied for few hours with antibiotic ointment.

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SCISSORS

VANNAS’ SCISSORS

Identification: It is much smaller scissors with spring action. It may be straight, curved
or angular.
Uses
To prepare conjunctival flap.
To cut 10–0 sutures in cataract or keratoplasty operation.
To cut trabecular flap in trabeculectomy.
To cut anterior capsular tags in ECCE.
To cut vitreous in open-sky vitrectomy, as in vitreous loss during ICCE or ECCE.
To cut corneal button after trephination in corneal grafting.
To cut iris in different types of iridectomy.

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CASTROVIEJO CORNEOSCLERAL SCISSORS

USES:
To enlarge corneal or corneoscleral
incision for
conventional ECCE and ICCE
To enlarge corneal incison in
keratoplasty.
Tu cut scleral and trabecular tissue in trabeculectomy

WESTCOTT SCISSORS
Description:
Spring-action scissors with fine, narrowed, blunt tips
that can be curved or straight.
Use(s):

σ Used for conjunctival dissection, incising the cornea,

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 OCCULOPLASTY
PUNCTUM DILATOR (NETTLESHIP’S)

Identification: It is a long narrow solid cylindrical instrument with a smooth conical

Uses
← To dilate the punctum and part of the canaliculus before introducing lacrimal
cannula for syringing.
To dilate the punctum for probing in case of congenital dacryocystitis.
To dialate the punctum and then probing to identify lacrimal sac during DCR operation.
For dilatation of the punctum in congenital or acquired punctal stenosis.
Before dacryocystography (DCG).
May be used as a marker (by dipping the pointed tip in gention violet) in squint or
retinal detachment operation.

LACRIMAL PROBE (BOWMAN’S)

Identification: It is a thin, long probe with round lip. It is made up of stainless steel or
silver. They are of different diameters (size 00 to 08). Each instrument has two different size
probes attached centrally with a flat handle.

∞
Uses: To probe nasolacrimal passage in:
Congenital punctal stenosis.
e
Congenital dacryocystitis—if probing fails to achieve the patency of nasolacrimal
←
passage then one should go for DCR.
During DCR to identify the exact position of lacrimal sac for giving incision on the
sac wall.

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BARRAQUER NEEDLE HOLDER

Identification: It is a
medium-sized spring needle holder with two narrow and fine
curved jaws.

-
Uses: It is used to hold the fine needles (of 6-0, 8-0 and 10-0 sutures) for:
Corneoscleral suturing after cataract operation.
Scleral suturing in squint, detachment and trabeculectomy operations.
Corneal suturing in penetrating injury or keratoplasty.
Suturing the mucosal flaps in DCR operation.
Sometimes in conjunctival suturing.

SPONGE HOLDING

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