C nstruments 25

COMMONLY USED OPHTHALMIC INSTRUMENTS

Can be grouped according to their function and shape as under
1. Lid speculums.
2. Forceps.
3. Hooks and retractors.
4. Needle holders.
5. Knives.
6. Scissors.
7. Clamps.
8. Calipers.
9. Instruments for cataract surgery and intraocular lens implantation.
10. Instruments for lid surgery.
11. Instruments for lacrimal sac surgery (DCT and DCR).
12. Instruments for enucleation and evisceration.

Lid Speculums

1. Eye Speculum with Screw

It has two limbs with a screw to adjust the limbs.

Uses: Eye speculums are used to keep the lids apart during surgical procedures such as cataract, glaucoma, squint,
Pterygium and removal of foreign body from conjunctiva and cornea.

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Forceps
1. Plain Forceps
It is simple forceps without any teeth.

Use: To hold the tissues during operation such as conjunctiva, scleral flap in trabeculectomy, skin during eyelid surgery
and nasal mucosa) flaps and lacrimal sac flaps in DCR operation.

2. Fixation Forceps
It has narrow or wide jaws. It has 2x3 or 3x4 teeth at the tip.

Use: To fix eyeball during the operation on the eyeball and to hold eyeball during forced duction test.
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J. Superior Rcctu s Holding Forceps
Jt is a tooth fo rceps w ith lx2 teeth.

Use: To hold the superior rectus muscle while passing a bridle suture under the superior rectus muscle.

4. Corneal Forceps
The forceps has very fine teeth (1X2) at the tip.

Dses: To hold the corneal or scleral edge (of incision) for suturing during cataract, glaucoma, repair of corneal and or
scleral tears and keratoplasty operations. ·
 402

5. Su tu re T:: in ~ 1:orcq
The forceps has ve ry fin e plain tips.

Uses: To hold the suture during suturing for cataract, glaucoma, repair of corneal and/or scleral tears and keratoplasty
operations.

6. Arru o-a's I n t r a a p sul ar (Cap nl e H o lding) Forc<'ps

It has a cup on the inner side of the tip of each limb.

Use: It is used to hold the lens capsule to remove the lens in intracapsular cataract extraction.

7. E p ilation forc eps

It has blunt and flat ends.

Use: To epilate the cilia in trichiasis and styc.

 r Ch~ er 25-0ph a1m-c Instrum 403

,.. ~ .. r t r _· F ,· L ,J>-'aticJ run

It is tbe mul tiple straight grooves (at •gh .

ese c be srraigbt or wfrh curved n d tangle to th e li mbs) near the tip and a Jocking medunism near the rin~ en
Th e n s.

Uses: To catch bleeding vessels dunng·

. the op era a· ons o f th e lids an d Iacnmal
· · and muscle stay sutures.
sac and to hold skin

Hooks an d Retractors
L Lem Exprc~so r (Ho k)
It is a fut medal handle with rounded curve at one end. Tip of the curve is knobbed.

Uses: To apply pressure on the Jim bus at 6o' dock position during the delivery ofiens in intracapsular cataract extraction
md to express the nucleus in extracapsuJar cataract extraction. It can also be used as a muscle hook.

?. .\1u ~d c:(St ra bhmus) Hook

lt is similar to the lens expressor in appearance but has a blunt guarding knob at the end to prevent muscle slippage.

1ses• Ti
le · o engage the extraocuJar muse Jes d urmg
· squmt
. surgery, enuc Ieatton
. an d retmal
. detachment. It can also be used
ns CXpressor.
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J . D e sm ar rc~ fktr,t ti r
It is a saddle- hapcd in trumcnt folded 011 it elf at on c11d .

Uses: To retract the lids during examination of the eyeball in cases of blepharospasm in children, in cases with marked
swelling and ecchymosis.

4. Cat's Paw Lacrimal Wound Retractor

It is fork-like with terminals bent inward.

Uses: To retract the skin during lacrimal sac and lid surgery.

5. Self-Retaining Lacrimal Wound (Muller's) Retractor

It is made up of two limbs with three curved pins on each engaging the edges of incision. The limbs are kept in retracted
position with the help of a fixation screw.

Use: To retract the skin during lacrimal sac surgery.

 405 Chapter 25-0phthalmic Instrumen
--- --- ---------------------------·',.
r,1eedle

1. pring Ac tion (Barraqrn.:r 's: Type) Needle Hold n

fh e j aws of needle holder are firmly serrated to hold th e fine needles firmly.

rked

Use: For passing sutures in conjunctiva, cornea, sclera and extraocular muscles.

2. Castroviejo's Needl e Holder

It is a medium-sized spring action needle holder.

:ed

Use: It is generally used extraocular surgery such as conjunctiva) suturing and squint surgery and also for intraocular
surgery.

3. Arruga's Steven, Silcock's and Kelt N eedle H older

It is a large needle holder, with and without locking device.

llse: Very commonly used in lid surgery and for passing superior rectus suture.
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I ii c t1 d {n;f" -I ccdk h
1. K<'ratomcs
. diamond-shape
It Iias a tbm . .
blade with a sharp ape.'< an
d tw cutting edges. Straight as well as curved ker t
° a ornes are
available in various size (2.8 mm , 3mm, 3.5mm, and 5.5mm).

Uses: To make the valvular corneal incision for entry into the anterior chamber for all modern techniques of cataract
surgery e.g. phacoemulsification and conventional ECCE.

2. 15° idc Port Entry Blade

It is a fine straight knife with a sharp pointed tip and cutting edge on one side.

Use: To make a small valvular clear corneal incision (commonly called as side port incision) in phacoemulsification. It is
also used for paracentesis.

3. Crescent Knife
It is a sharp curved, bevel up knife having cut splitting action at the tip and both the sides.

Uses: To make tunnel incision in sclera and cornea for phacoemulsification and manual small incisions cataract surgery.

4. Tooke's Knife
It has a short flat blade with a semicircular blunt dissecting the edge.

Uses: It used to sepa~ate the conjunctiva and subconjunctival tissue from the sclera and limbus, to separate partial thickness
lamella of sclera durmg trabeculectomy and to separate corneal lame Ila in lame liar keratoplasty.
 Chapter 25-0phthalmic Instruments 407
- --------------------------- --
- , Cystoto m c or C ;\psulotomc
...

,.
; is a small needle knife with bent tip, which is sharp on both the edges. Disposable cystotome is prepared by bending th e
1
dP 0 ( di spo ab le 26 gauge or 30 gauge hypodermic needle at 90 degree and shaft at 45 degree.

Disposable cystotome

Vses: For doing anterior capsulotomy or capsulorhexis during extracapsular cataract extraction.

6_ foreign Body Spud

It has small, stout and flat blade with blunt tip and edges on both sides.

Use: To remove the corneal foreign body.

Scissors
1. Plain Straight Scissors
It is a fine pointed scissor with straight sharp cutting blades.

Uses: It is used to cut conjunctiva) sutures, eyelashes and muscles.

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Uses: To cut and undermine conjunctiva and skin in various operations.

3. Corneal Scissors or Section Enlarging Scissors
Their cutting blades are kept apart by spring action.

Uses: To enlarge the corneal or sclerocorneal incision in cataract surgery.

 Chapter 25- 0phthalmic Instruments
409
~ ., 1 . . •
4- De c e-r s et or
fh ey are fine scissors with small blades directed at right angles to th e arms.

Uses: To perform iridectomy, for cutting a prolapsed formed vitreous.

5. pring ~ ci ors (Wcstcott's)

Uses: It is used for cutting and undermining conjunctiva in various operations and cut sumres.

6. Vannas Scissors
It is a fine delicate pair of scissors with sharp edges.

Uses: lt is used to cut vitreous during a prolapsed vitreous.

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C alipers
Castroviejo Calipt>r
· a d 1vider-like
I t 1s " • attac I1 cd a gra duated c:ilc (in mm) . Its other arm can be moved by
instrument, to one arm of w 11ic h 1s
a screw over the scale.

Use: It is used to take measurement during squint, ptosis, retinal detachment and pars plana vitrectomy surgery.

Clamps
1. Chalazion Clamp
It consists of two limb like forceps, which can be clamped with the help of screw.

Uses: To fix chalazion and achieve haemostasis, during incision and drainage.

2. Ptosis Clamp
It consists ofD-shaped _plate _opp~sed by_u-shaped rim, which can be tightened by the help of screw, clamp the ti ~uc. The
plate is toward the conJunct1val side so 1t protects the eye during lid surgery on the skin side. Till: screw face the outer
side and the handle is always situated on the temporal side.
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J. Entn pi<t11 ,I II I
Jt ha platr, hi h i pl. rd uuder th ' c ·lid, a ·urvcd hook. , hi h will b' on the outer ski • of th , lid and • r -w to tight
y the lid.

Uses: It is used for entropion surgery to hold the eyelid and create the haemostasis.

ADDITIONAL INSTRUMENTS FOR CATARACT SURGERY AND INTRAOCULAn LEN

IMPLANTATION
1. Blade Braker
It has a handle and two blades to fo'( the part of blade.

Use: It is used to fix the part of atom blade which is used during cataract for corneal incision.

2. Wire Vectis
It is a circular, oval structure attached to a metallic handle.

Uses: It is used to remove dislocated or subluxated lens, and nucleus in ECCE .

.e
3. Two-Way Irrigation and Aspiration Cannula
:r
It is available in various designs, commonly used are simcoe, classical or reserve cannula.
 412

Uses: For irrigation and suction oflens matter in extracapsular cataract extraction. Aspiration ofhyphaema.

4. Iri Repos itor

It is a delicate, flat, metallic, straight or bent blade with blunt edges and tip attached to a handle.

Uses: To reposit the iris in the anterior chamber in any intraocular surgery.

ADDITIONAL INSTRUMENT FOR INTRAOCULAR LENS IMPLANTATION

1. Kelman McP her son Forceps (IOL Holding Forceps)
This is fine forceps with bent limbs.

Uses: To hold the haptics of IOL during its placement.

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----- z, Sin key H o or IOL Di le r

It is a fin e instntment \\i th a bent rip, w hich engag th dialing holr f th e I L.

Use: To dial the IOL for proper positioning in the capsular bag.

3. Hydrodisscction Cannula
It is a single bore 25G, 27G or 30G cannula with 45 degree angulation at about 10-12 mm from the free end.

Uses: To perform hydrodissection (separation of posterior capsule from the cortex) and hydrodelineation (separation of
cortex from the nucleus) in phacoemulsification.

4. Chopper
It is a fine instrument, resembling a hook in shape. The inner edge of the bent tip is used as the cutting edge.

- -- t - I - t -- r - t -r- - --,-- I t
- .

Uses: It is used to split or chop the nucleus into smaller pieces.

ADDITIONAL INSTRUMENT FOR LID SURGERY

Chal:lziou Scoop
It is a small cup with sharp margins attached to a narrow blade.

Uses: To scoop out the contents of chalazion during incision and curettage.

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1. Pun c tum Dilato r ( '<- ttl hip" )
FOH LACRI C ~URGE I1Y

It is a cylindrical corrug;i ted metal handle with conical pointed tip .

Uses: To dilate the puncrum and canaliculus during syringing, probing and OCR operation.

_____.._____
~- Lacri m a l Probe (Ilo",n an 's)
These are sets of straight metal wires of varying thickness, with blunt rounded end and flattened central part.

Use: To probe nasolacrimal duct in congenital blockage and OCR operation.

3. Lacrimal C a nnula
It is a ling curved hypodermic needle with blunt tip.

Use: For syringing the lacrimal passages.

4. Bone Punch
It has a spring handle with two blades.

Use: To enlarge the boney opening during DCR operation.

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 Chapter 25-0phthilini... Irutrum nt 1:;

--- . ·storhin s om,· (DCR Burr

It has a handle at one end serrated burr at the other end.

Use: It used to create a hole in the lateral wall of nose.

6. Bone Nibbler

Use: It is used to break the bone and enlarge the hole created by DCR burr.

ADDITIONAL INSTRUMENTS FOR ENUCLEATION AND EVISC ER A.T ION

Evisceration Spatula
It consists of a small rectangular blade with slide convex surface and blunt edges attached t the handk.

lJse: It is used to separate the uveal tissue in evisceration operation.

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Use : It used for distant direct ophthalmoscopy and fundus examination.

APPLANATION TONOMETER

Use: It used to measure the intraocubr pressure.