INSTRUMENTS IN

OPHTHALMOLOGY
Dr. Kamini Prajapati
Associate Professor
M & J Institute of Ophthalmology
&
Dr. Kanan Sedani
Senior Resident
M & J Institute of Ophthalmology
No financial disclosures
 Speculum:
Uses:
To retract the the lids apart for visualisation and surgical
access during:

1. Any intraocular operation such as cataract surgery

and glaucoma surgery

Wire speculum 2. Any extraocular surgery e.g., squint surgery,

pterygium surgery
3. Enucleation and evisceration operation
4. Removal of conjunctival and corneal foreign bodies

Universal eye speculum Barraquer eye speculum with solid blades

Castroviejo’s Calliper:

Uses:
1. Squint surgery: for recession and resection measurements

2. Ptosis surgery

3. Measuring the corneal diameter

Mosquito Artery Forceps:

Uses:
1. To catch the bleeding vessels during operations of the lids and lacrimal sac.
2. To hold the skin and muscle stay sutures
3. To hold small ‘pea-nut’ gauze pellets for blunt dissection in lacrimal sac surgery and
other extraocular surgery
4. To hold gauze pieces while packing the socket after enucleation or exenteration
operation
Stevens Tenotomy Scissors:

Uses:
1)To separate the delicate tissues without damaging the surrounding area in
oculoplastic operations and squint surgery

2) To cut optic nerve in enucleation operation

3) To cut superior rectus suture in cataract surgery

Arruga needle holder:

Uses:
To hold heavy gauge needles (thicker than 6-0) used in

1. Lid surgery
2. Passing bridle suture under superior rectus muscle
3. Skin and muscle suturing
Barraquer’s Needle Holder:

Uses:

1. To hold fine gauge needles (5-0 or finer); used mainly for intraocular
incisions for passing sutures in the conjunctiva, cornea, sclera
2. To suture extraocular muscles in squint surgery
Lim’s Corneoscleral Forceps:

Uses:
To hold the cornea or scleral edge (of incision) for suturing during

1. cataract, glaucoma surgery

2. repair of corneal and/or scleral tears
3. keratoplasty surgery
Pierse Hoskins forceps

Uses:
1. For firmly grasping delicate tissues like the cornea without causing tissue
damage.
2. For corneo-scleral suturing
De Wecker’s Scissors:

Uses:
1) It is used to perform iridectomy, iridotomy

2) To cut the prolapsed formed vitreous and pupillary membrane

Utrata Capsulorhexis forceps

- Used for continuous curvilinear

capsulorhexis during cataract surgery.
Dastoor’s Superior Rectus Holding Forceps:

Uses:
1. To hold the superior rectus muscle while passing a bridle suture under it
2. To stabilize the eyeball during any operation such as cataract surgery,
glaucoma surgery, corneal surgery, etc
Tying Forceps:

Uses:
For tying knots while suturing corneal tear, scleral tear, scleral tunnel in
small incision cataract surgery etc.
Epilation Forceps

- used for the removal of trichiatic lashes

Kerman McPherson’s Forceps:

Uses:
1. To hold the superior haptic of IOL during its placement
2. To tear off the anterior capsular flap in ECCE
3. Can be used for tying 8-0 and 11-0 sutures
Bard Parker Handle With Blade:

Bard Parker handle with 11 number blade

Uses:
1. For removal of very small lesions
2. For making accurate stab incisions in chalazion surgery with the help of a
chalazion clamp along the posterior lamellae
Bard Parker handle with 15 number blade

Uses:
1. For marking corneo-scleral section for cataract extraction
2. Marking scleral flap in trabeculectomy
3. For scraping of corneal infiltrate for microbiological examination.
Crescent Knife:

Uses:
To make the sclerocorneal tunnel incision in phacoemulsification, small incision
cataract surgery (SICS), and scleral flap in trabeculectomy
Keratome:

Uses:
1. To make valvular corneal incisions through the scleral tunnel for entry into
the anterior chamber in cataract surgery (SICS and phacoemulsification
techniques)
2. Also used in other intraocular surgeries, iridectomies and paracentesis
Micro-Vitreo-Retinal Blade and side port:

Uses:
1. Used to make a small valvular , self sealing clear corneal incision which is
0.9-1.0 mm wide (commonly called as side port incision) in
phacoemulsification
2. Limbal incision in intraocular surgeries such as pars plana vitrectomy
Cystitome:

Uses-
For doing anterior capsulotomy or capsulorhexis during cataract surgery
Capsulotomy scissors

- To cut the anterior capsule flaps post capsulotomy.

Castroviejo’s Corneo-Scleral Scissors:

Uses:
1. To enlarge corneal or corneoscleral incision for conventional intracapsular
and extracapsular cataract extraction surgery
2. To enlarge corneal incision in keratoplasty operation
3. To cut the scleral and trabecular tissue in trabeculectomy
Vannas Scissors :

Uses:
1. For cutting anterior capsule of the lens in extracapsular
surgery
2. For cutting fine sutures such as 10-0 nylon
3. For cutting inner scleral flap in trabeculectomy
4. For doing pupillary sphincterotomy
5. For performing iridectomy
6. For cutting pupillary membrane
7. For cutting lamellar corneal tissue
Barraquer Iris Spatula (repositor) :

Uses:
1. To gently reposit the iris in the anterior chamber in case it prolapses out
during any intraocular surgery
2. To break synechiae at the pupillary margin
Wire vectis:

Uses:
1. To apply pressure on the sclera superiorly to depress the posterior lip of the
wound which facilitates lens delivery by tumbling or sliding technique in
ICCE and nucleus delivery by sliding technique in ECCE

2. To remove dislocated or subluxated lens

Simcoe Irrigation-Aspiration Cannula:

Uses:
1. For manual aspiration of the lens cortex in cataract surgery with dual
function of irrigation and aspiration
2. For aspiration of hyphema or exudates from the anterior chamber
3. To remove viscoelastic material at the end of the surgery
Smith lens expressor:

Uses:
1. To express the nucleus in extracapsular cataract extraction or intracapsular
cataract extraction
2. It can also be used as muscle hook if the latter is not available
3. Also used along with wire vectis to extract out the dislocated lens
Jameson Muscle 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

Jaeger’s Lid Plate:

Uses:
To protect the globe and support the lid during entropion, ectropion, ptosis
and other lid surgeries
ENTROPION CLAMP

- Self retaining hemostatic clamp used for entropion and ectropion surgeries
- Plate is kept towards the globe side.
BERKE’S PTOSIS CLAMP

USE:
-instrument is designed to hold levator muscle during LPS resection.
-It has hockey stick like configuration with locking mechanism.
-It allows holding LPS muscle without crumpling it and put traction over LPS during suturing
Nettleship Lacrimal/ punctum Dilator:

Uses:
To dilate the punctum and during syringing, probing,
canaliculus dacryocystography, DCT and DCR
procedures
Bowman Lacrimal Probe:

Uses:
[Link] checking for patency of the lacrimal drainage system to determine the
presence of a hard stop or soft stop

[Link] dacryocystectomy to identify the common canaliculus for cauterization,

once the sac is removed
27 GAUGE CANULA

-used lacrimal sac syringing

- used for hydrodissection and hydrodilineation in cataract extraction surgery
Cat’s Paw Lacrimal Wound Retractor:

Use:
To retract tissues during DCT and DCR procedures
Desmarre’s lid retractor:
USES:
[Link] or double-everting the upper lid
2. Everting lid during ptosis or entropion surgery
[Link] wound edges to give maximal exposure of surgical field
[Link] push away orbital fat from surgical field as in levator palpebraesuperioris (LPS) resection.
Evisceration curette:

Use:
To separate the uvea from the sclera prior to removing the intraocular contents in
evisceration
Enucleation scissors and Optic Nerve guard

Used while enucleation , Enucleation scissors are used to cut the optic nerve while Optic
nerve guard is used to protect the globe.
Chalazion Clamps:

Use:
To fix the chalazion and achieve haemostasis during incision and curettage
Chalazion Scoop:

Use
To scoop out contents of the chalazion during incision and curettage
Kerrison’s Punch:

Uses:
In dacryocystorhinostomy to enlarge the bony opening by punching the bone from
margins of the opening
Lacrimal sac dissector and curette:

Use:
Blunt end is used to gently dissect the lacrimal sac from the surrounding tissues
without damaging the sac
Freer Periosteal Elevator:

Use:
To separate the periosteum from the bone prior to making the bony opening in
DCR and in orbital decompression
Hammer and Chisel:

Use:
To cut bone during DCR and orbitotomy
Wet field bipolar Electrocautery Probe :

Uses:
To cauterize episcleral and conjunctival blood vessels before making sclerocorneal
tunnel in small incision cataract surgery, phacoemulsification surgery
6-0 vicryl:

Use:
1. Double arm suture used in squint surgery for passing through muscle and sclera
2. Scleral port closure in retino-vitreal surgery
3. Skin closure (lid tear repair) in oculoplastic surgery
4. Traction suture through cornea
8-0 vicryl:

Use:
1. Conjunctival closure
2. Scleral tear repair
4-0 silk:

Use:
1. To take muscle stay suture e.g. Superior Rectus stay suture in cataract surgery
2. To take lid stay suture in oculoplastic surgery
6-0 silk:

Use:
For skin closure
10- 0 nylon:

Use:
1. Closure of corneal wound

2. Flap suture in trabeculoplasty

3. Scleral suture in cataract surgery (SICS)

Schiotz tonometer

Uses:
To measure the IOP by Indentation
Perkin’s applanation tonometer:

- portable hand held applanation tonometer for measurement of IOP

- suitable for bedside tonometry
GOLDMANN’S THREE MIRROR GONIOLENS

USES:
-It is an indirect gonioscopy lens
- one of the mirrors used to see angle
structures and helps in diagnosis in glaucoma.
-other mirrors are used to see structures at the
equator and posterior pole
DIRECT AND INDIRECT OPHTHALMOSCOPE
DIRECT VERSUS INDIRECT OPHTHALMOSCOPE
OTHER LENSES USED:
Strong condensing lenses for viewing the fundus, where a real inverted
image is formed and seen.

FOR INDIRECT OPHTHALMOSCOPY: FOR SLIT LAMP BIOMICROSCOPY:

20D, 28D 78D, 90D

INTRAOCULAR LENSES (IOLS)
TYPES OF IOLs
Foldable and Non-foldable IOLS
Anterior chamber IOL and Iris fixated IOL
IOL Injector:

Uses:
For the safe implantation of foldable intraocular lens during phacoemulsification
surgery.
SNELLEN’S DISTANCE VISUAL ACUITY CHART

Uses:
For distant visual acuity testing
RETINOSCOPE
- Two types:
1) Mirror retinoscope: plane mirror and
Priestley smith mirror
2) Streak retinoscope

-Use:
For refraction testing

Streak retinoscope
RETINOSCOPY: PRINCIPLE OF NEUTRALISATION
Reflexes produced by the streak
retinoscope.
[Link] starting position, before
beginning sweeping movements.
B. "With" motion : The reflex moves in the
same direction as the streak of light,
indicating the need fora stronger
converging (plus)lens. The eye is relatively
more hyperopic than the lenses are
correcting.
C."Against" motion: The reflex moves in
the direction opposite that of the streak,
indicating the need for a stronger
diverging(minus) lens. The eye is relatively
more myopic than the lenses are
correcting.
D. Neutralization point: There is no
apparent movement of the reflex, and the
pupil is filled with a red glow.
ISHIHARA’S COLOUR VISION CHART

Use:
To check for colour blindness
For red green colour blindness specifically
AMSLER GRID

USE:
-for patients with metamorphopsia
- monitoring of patients with macular disease
TRIAL SET WITH LENSES

consists of :
- trial frame
- concave lens
-convex lens
- Cylindrical lenses
- Prisms
- pinhole
- occluder
- stenopic slit
TRIAL FRAME:
CONVEX LENS

Used in Hypermetropia i.e., to

correct far-sightedness

To identify:
Move the lens and see the
movement and size of an
object

For convex lens there is

MOVEMENT IN THE OPPOSITE
DIRECTION AND
MAGNIFICATION OF IMAGE.
CONCAVE LENS

Concave lenses are most commonly

used to correct myopia which is also
called near-sightedness

To identify:
Move the lens and see the
movement and size of an object

For concave lens there is

MOVEMENT IN THE SAME
DIRECTION AND MINIFICATION
OF IMAGE.
CYLINDRICAL LENS

- used for correction of astigmatism

-for identification
distortion of image is seen when
lens moved
MADDOX ROD

-to subjectively detect and

measure a latent, manifest,
horizontal or vertical
strabismus for near and
distance.
PRISM

-used to measure the amount of

diplopia or double vision
OCCLUDER, PINHOLE AND STENOPIC SLIT

- occluder: used to occlude eye for visual acuity testing

-pinhole: used to differentiate between low vision due to refractive error versus other causes
- stenopic slit: used to determine axis for cylindrical lens
PINHOLE
STENOPIC SLIT FOR FINCHAM’S TEST
Placido disc

-used to assess the shape of the

anterior surface of the cornea
- a series of concentric rings is
projected onto cornea and their
reflection viewed by the
examiner through a small hole in
the centre of the disk .
Jackson cross cylinder

-used to refine the axis and power of the

cylinder
-used for astigmatic refraction
CONTACT LENS:
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