OPHTHALMOLOGY

PRACTICALS - VIVA
INSTRUMENTS
• Fine + bent limbs + no holes in
handle
• Hold superior haptic of IOL
• Tear off anterior capsular flap in
ECCE
• Suture tying
• Fine long curved sharp tip
without teeth + holes in handle
• CCC in manual SICS or phaco
• Avoid damage to other
intraocular structures
• S shaped; 1:2 teeth at the end
• Curvature at tip fits curvature of
the eyeball
• Use – catch belly of SR while
passing bridle suture
• Also used to catch IR in
keratoplasty
• No teeth, ends are blunt, inner
surface has fine serrations for
better grip
• Hold conjunctiva for surgery and
subconjunctival injection
• Tie sutures
• Hold scleral flap during
trabeculectomy
• Hold skin during eyelid surgery
• Hold nasal mucosal flap
• Has a catch for locking
• Use – hold lid stitches and SR
stitches and then fix suture
• Hemostasis during DCR or DCT
• Hold muscle stump during
enucleation
• Hold entire lacrimal sac prior too
excision in DCT
• Aka Cilia Forceps
• Remove misdirected eyelashes in
trichiasis (Trachoma)
• Remove involved eyelash in stye
• Not ideal method since hair root
intact therefore can grow again
• So best method is destruction of
hair root
• Done by electrolysis,
electrodiathermy, cryosurgery
• Corneoscleral forceps
• Very fine teeth at tip
• Hold corneal or scleral edge fir
suturing during cataract,
glaucoma, repair of corneal or
scleral tears and keratoplasty
• Medium sized with 3 – 4 teeth
• Fix eyeball during sx – cataract,
pterygium, glaucoma,
• Catch Superior rectus
• FDT for squint
• Hold sponge piece, gauze piece,
cotton ball
 Scissor Needle Holder
Handle is flat Handle is rounded since
we want the needle to
rotate while taking a bite
for suturing
Tip is pointed for cutting Tip is blunt
Blades are flat Blades are heavy and
rounded

3 types of needle holders

Barraquer: Finely serrated. Used for passing sutures in
conjunctiva, cornea, sclera, and EOM. Spring action.

Castroviejo’s – S shaped locking system – conjunctiva and

squint surgery

Arruga’s – flat and broad plate to accommodate surgeon’s

thumb- lid surgery and passing SR suture
• Corneal scissors used for – enlarge
corneal or corneoscleral incision for
conventional ICCE, ECCE,
kertoplasty; cut scleral and
trabecular tissue in trabeculectomy;
cut conjunctiva
• Capsulotomy – Vannas scissors. Also
used for cutting 10-0 sutures;
iridectomy; cutting pupillary
membrane
• Since capsule is smaller than cornea
therefore the scissor will also be
smaller
15 degree side port blade
 • 4 keratomes = 2 sharp + 2 blunt
• 2 Sharp = 1. With one cutting edge
– 15 degree side port and 2. with
two cutting edges – entry blade
(keratome)
• 2 Blunt – 1. Tongue shaped –
crescent knife(thinner) – used for
making self sealing corneoscleral
tunnel in cataract so and 2.
Truncated in front – extension
Don’t exactly go with blade
• Crescent Knife USES
1. Self healing corneoscleral
tunnel in phaco, sics,
trabaculectomy
2. Separate conjunctiva and
sunconjunctiva from sclera and
limbus when limbal based flap
sx are done in trabaculectomy
3. Separate pterygium head from
underlying corneal lamellae
4. Separate corneal lamellae in
lamellar keratoplasty
• MVR/V lance blade
• Uses same as 15° side port entry
blade- to make small valvular
clear corneal incision in
phaco and other IO Sx (PPV)
• KERATOMES
• Come in various sizes (2.8, 3,
3.5 mm, 5.5 mm)
• USES: to make valvular
corneal incisions for all
modern techn. Of cataract,
iridectomy.
Sharp
keratome
• Von Graffe’s knife – not used
anymore
• Historically used for
corneoscleral incision,
iridectomy, four dot iridectomy
for iris bombe, pars plana
incision for lensectomy and
vitrectomy
• Aka Sinkskey hook
• Fine and stout with bent tip
• Use – dial PMMA non foldable
IOL for proper insertion
• Manipulate nucleus in phaco
surgery i.e. nucleus rotation,
cracking the nucleus and feeding
the nucleus to the phaco tip
• Divider like instrument
• Take measurements during sx for
squint, ptosis, RD, pars plana
vitrectomy
• Measure corneal diameter and
horizontal iris diameter
• Remove subluxated lens
• Remove anteriorly dislocated
lens in ICCE and nucleus in ECCE
• Lid clamp – D shaped plate
against U – shaped rim
• Two clamps used – one for Rt
upper and lft lower and other for
lft upper and rt lower
• Plate kept towards conjunctival
side and rim kept towards skin
side, handle is placed temporally
• Self retaining
• Disadv: Less operating field,
Pressure necrosis possible
• Use: Lid surgery – ectropion and
entropion
• Protects eyeball, supports lids +
hemostasis
BONE PUNCH
• Bone punch
• Spring handle + two blades
attached at right angles
• Upper blade has small hole with
sharp cutting edge, lower blade
has cup
• Use : bone punch during DCR
• Two different sized punches are
needed to make opening of
about 10 mm diameter
• Simcoe’s irrigation aspiration two way
cannula
• The port near the index finger is
connected to a bag congaing BSS or
Ringer’s lactate and is used for irrigation
• The port present near the little finger is
attached to the syringe, negative
pressure is created by suction and is
used for aspiration
• Use : 1. I and A during of cortex
ECCE with PCIOL
2. Remove blood in hyphema
3. Remove viscoelastic after IOL
insertion
• IOL injector
CORNEAL PRESERVATION TECHNIQUES

• SHORT TERM STORAGE (24-96 HOURS)

1. Moist chamber, 4°C, upto 24 hours
2. McKarney Kaufmann’s medium (MK)upto 96 hrs (m/c used in India)

• INTERMEDIATE TERM ( UPTO 2 WEEKS)

1. Optisol GS (m/c used in USA)

• LONG TERM PRESERVATION (UPTO MONTHS/YEARS)

1. Glycerine preservation (3-4w)
2. Organ culture method (upto 25 days)
3. Cryopreservation (upto 1 year) of corneal button at -70°C
• ILM – internal limiting
membrane of the retina
• It is thin and long and thus can
help in removing the ILM which
is the most superficial layer of
the retina
• Surgery needed for certain
retinal pathologies
• Trial frame – used for subjective
refraction
• Capsulotome/cystitome – 26
guage
• Needle is bent twice
• Used for
capsulotomy/capsulorrhexis
during ECCE
• For cutting corneal button during
eye donations/keratoplasty
• 3 parts: 1. Circular blade; 2.
Cover to protect sharpness of
blade; 3. Adjustable inner core
or obturator which helps
determine depth of cornea to be
cut – imp for lamellar
keratoplasty
• Now disposable trephine used
• It is a probe which helps in
vitrectomy
• Works on the principle of optical
fiber
• Helps for illuminating vitreous
during procedures of posterior
segment
INTRA OCULAR LENS
• QUESTIONS:
1. POWER
2. TYPES DEPENDING ON
LOCATION, MATERIAL, POWER,
REFRACTORY ABILITY
DRUGS – ANY DRUG TO BE DESCRIBED
UNDER FOLLOWING HEADERS
• FULL NAME WITH CONCENTRATION
• CLASS
• MECHANISM OF ACTION
• INDICATIONS
• CONTRAINDICATIONS
• SIDE EFFECTS
• SPECIAL FEATURES
• OTHER FOLLOW UP QUESTIONS MAY BE ASKED
STEROIDS

Steroid induced cataract is posterior

subcapsular cataract
Glaucoma is open angle glaucoma
GTCS: Glaucoma – topical and Cataract
with Systemic
• DIFLUPREDNATE
• STEROID
LOTEPREDNOL ETABONATE +
TOBRAMYCIN SUSPENSION
• STEROID + ANTIBIOTIC
• Tobramycin: against
psudomonas aeruginosa
and proteus
• Bactericidal
• AMGlycoside
• Mostly against gram
negative
KETORAL TROMETHAMINE +
OFLOXACIN
• TERTRACYCLINE
1. BROAD SPECTRUM
2. Bacteriostatic
3. Oral, ointment, drops- used
against TRACHOMA
4. Prophylaxis for trachoma
5. (BD x6w)
MOXIFLOXACIN CIPROFLOXACIN
COSMOX

1. CIPROFLOXACIN, NORFLOX
2. OFLOXACIN
3. SPARIFLOXACIN
4. MOXIFLOCACIN
ACICLOVIR EYE OINTMENT
GANCICLOVIR GEL
• Class: Antiviral
• Indications:
• Recurrent ocular herpes
• CMV retinitis IN
iMMUNOSUPRRESIVE PATIENTS
ITRACONAZOLE SUSPENSION

For filamentous fungi (aspergillus and fusarium) NATAMYCIN, AMB

FOR YEAST: AMB, NYSTATIN
 FUNGAL CORNEAL ULCER
• Injury by vegitative material
• By animal tail
• 2° fungal ulcer in I/C patients
suffering from herpetic
keratitis, bullous keratopathy
• INDISCRIMIINATE USE OF
ANTIBIOTICS, STEROID
(steroids convert symbiotic
saprophytes into facultative
pathogens)
• C/F
1. Greyish white, dry looking, rolled out
margins
2. Pigmented (dematiaceous)
3. Delicate feather like extentions
4. sterile immune ring
5. Mutiple small satellite lesion
6. Big, non sterile, hypopyon (as fungi can
penetrate into AC without perf)
7. Endothelial plaques
AZITHROMYCIN EYE DROPS
TOBRAMYCIN AND DEXAMETHASONE
SOLUTION

Protein
synthesis
inhibitor

f/u – purpose of using steroid and antibiotic together

BROMFENAC
KETOROLAC TROMETHAMINE +
HYDROXYPROPYLCELLULOSE

HYDOXYPROPYL METHYL
CELLULOSE ARE LUBRICANT EYE
DROPS USED IN CASES OF DRY
EYES, VIT A DEFICIENCY, POST OP
CARE
D - PANTHENOL
• LUBRICANT GEL FOR DRY EYES
CARBOXY METHYCELLULOSE
SODIUM EYE DROPS
• FOR DRY EYES
ATROPINE EYE DROPS

Atropine also used for

1. Penalizing/blurring of normal eye in treatment of amblyopia Ocular s/e – blurred
2. Sympathetic ophthalmitis vision d/t cycloplegia
ATROPINE EYE OINTMENT
HOMATROPINE EYE DROPS – 2% drops
• Same as atropine
• Used for individuals between 5
and 25 years
• One drop every 10 mins for 6
times
• Retinoscopy done 1-2 hours
after it (90 mins)
• Peak effect 60-90mins
• Effect lasts for 48-72 hours
TROPICAMIDE EYE DROPS
LIGNOCAINE + ADRENALLINE
INJECTION
• CLASS: Anaesthetic and adrenergic
• MOA: Inhibit sodium channels
• 2ND year pharmac answer
• Increased duration
• Less systemic side effects
• Vasoconstriction
• Use: Anaesthesia in surgeries or
procedures
• S/E: Lignocaine – drowsiness,
paresthesia, convulsions
PARACAIN
• Similar to lignocaine
• Use – tonometry applanation
• Scraping of corneal ulcer for
investigations
MK/OPTISOL MEDIUM

F/u questions on keratoplasty

6-0 ABSORBABLE VICRYL SUTURE
BRINZOLAMIDE, DORZOLAMIDE
• CLASS: TOPICAL CARBONIC ANHYDRASE INHIBITOR
• MOA: REDUCE PRODUCTION OF AQEOUS HUMOR
BY ALTERING ION TRANSPORT ACROSS CILIARY
BODY
• USE: 2ND LINE FOR REDUCING IOP IN OAG AND
ACG
• S/E: LOCAL - BURNING, LOCAL ALLERGIC
REACTION,
SYSTEMIC - PARASTHESIA, URINARY FREQUENCY,
ELECTROLYTE – METABOLLIC ACIDOSIS D/T BICARB
DEPLETION, POTASSIUM DEPLETION, GI S/E;
APLASTIC ANEMIA; BONE MARROW SUPRESSION;
RENAL CALCULI; DYSPEPSIA
• C/I: SHOULD NOT BE COMBINED WITH OTHER
DRUGS CAUSING HYPOKALEMIA - DIURETICS
SODIUM CHLORIDE OPHTHALMIC
OINTMENT
• USED FOR DEHYDRATION OF
CORNEA IN CASE OF CORNEAL
EDEMA
TIMOLOL MALEATE EYE DROPS
OLOPATIDINE
ALCAFTADINE
• Antihistaminic + Mast cell
stabilizer
• Used in allergic conjunctivitis
• Like olapatidine
AZELASTINE
• COMBINED ANTIHISTAMINIC
AND MAST CELL STABILIZER
RETINOX
• Retinox Capsule is an Ophthalmic Antioxidant. It
helps to maintain good eye health and proper
functioning of the retina, for presbyopia, macular
degeneration, dry eye and cataracts. Lutein,
Zeaxanthin belong to the xanthophyll family of
carotenoids and are the two major components of
the macular pigment of retina. They are the only
carotenoids found in both the macula and lens of
human eye and have dual functions in both tissues to
act as powerful antioxidants and to filter high-energy
blue light.
• Omega-3 fatty acids also may help proper drainage of
intraocular fluid from the eye, decreasing the risk of
high eye pressure and glaucoma. Astaxanthin helps
to prevent and treat certain eye conditions. It used to
reduce eye strain and protecting against age-related
macular degeneration (ARMD).
BIMATOPROST/ LATANOPROST
CYCLOPENTOLATE
LENSES
• First identify spherical vs cylindrical
• Then convex or concave
• Prism may also be kept
Spherical
Will have handle
Will not have two lines on the lens
indicating axis of the cylinder
On rotating spherical lens there is no
distortion of image
Object moves in both directions i.e
horizontal and vertical
Cylindrical
Will not have handle
Will have two lines on the lens indicating
axis of the cylinder – power of the
cylinder is perpendicular to the axis of
the cylinder
On rotating cylindrical lens there is
distortion of image because power is
present only in one axis
Object appears to move only in one
direction
Use: 1. Correct astigmatism
2. Cross cylinder for subjective refraction
and checking power of cylindrical lens
 Convex
Convex Concave Concave
Startthe
Start by feeling by feeling the lens
lens – thick – thick inThin
in centre centre and thin
in centre andin thick
periphery
in periphery
and thin in Thin
periphery
in centre and thick in periphery
Magnification
Magnification of image of image Minification of image
Image moves Minification
in direction of opposite
image to the Image moves in same direction as the
Image
motion of the lensmoves in direction opposite to the motion of the lens
lens
Uses : Image moves in same direction asUses: the lens
Uses
1. Since plus lens: therefore used to 1. Correction of myopia
correct Since plus lens therefore
hypermetropia, aphakia, used to 2.
correct hypermetropia,
Hruby lens for fundus examination
presbyopiaaphakia, presbyopia
2. ObliqueOblique
illumination examination
illumination for
examination for magnification
magnification
Indirect ophthalmoscopy
3. Indirect ophthalmoscopy
Magnifying
4. Magnifying lesn lesn
Uses:
Image is real Image is virtual and erect
Correction of myopia
Black Hruby lens for fundus examination Red
Image is real
Image is virtual and erect
Black
Red
MADDOX ROD
• Converts point image into line
• Used for testing heterophoria
• Test latent squint for distance
• Test Macular function in
presence of opaque media
Uses of Cylindrical lens

To correct astigmatism
As Cross cylinder used to check refraction subjectively
maddoc rod consists of powerful convex cylindrical lenses mount together

• USES OF CONVEX LENS

• Uses of CONCAVE lens
1. Correction of HM, Aphakia,
presbyopia 1. Correction of Myopia
2. In oblique illumination (loupe 2. As Hruby lens for fundus
and lens) examination examinationwith slit lamp
3. Indirect Ophthalmoscopy
4. As magnifying lens
USES OF PRISM

• DIAGNOSTIC (to measure angle

of deviation- objective test)
1. Prism bar cover test
2. Krimsy Test
3. Aslo used in various
instruments like gonioscopes,
keratometer, applation
tonometer
• Therapeutic use
1. To relieve diplopia in patients
with decompnsated phorias
and small tropias
2. For exercises to develop
fusional reserves
PIN HOLE
• VISION IMPROVES – RE
• WORSENS – MACULAR ERROR
• REMAINS THE SAME – OPACITY
IN MEDIA
• ALSO HELPS IN CONFIRMING
POWER OF LENS IN SUBJECTIVE
REFRACTION
STENOPAEIC SLIT • 1 mm wide slit
• Was earlier used to check correction of
astigmatism
• When placed in front of the the allows
clearest vision when rotated into the
axis of astigmatism
• DETECTING ANGLE OF CYLINDRICAL
LENS
• FINCHAMS TEST TO DIFFERENTIATE
COLOURED HALOS
• IF DISTORTED – DUE TO IMMATURE
CATARACT
• IF INTACT – DUE TO GLAUCOMA