Common Oculoplastic Surgeries: A Nurse s View
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- Meredith Allison
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1 Common Oculoplastic Surgeries: A Nurse s View Sandy Burnett, ASN, RN, BA UF Health, Shands Hospital Gainesville, FL USA Objectives 1) Identify the anatomic deficit causing the eyelid malposition 2) Describe the surgical technique used to repair it 3) Discuss nursing care before/after surgery The False Mirror by Rene Magritte
2 Eyelid Problems for Centuries 19 th Century Ptosis c. 1 st -3 rd Century, Egyptian lower lid laxity
3 15 th Century, French Nun, lacrimal fistula
4 Lumps and Bumps
5 Malposition of Lower Eyelid
6 21 st Century Medicine vs Medieval Times
7 Common Minor surgical procedures using only a local anesthetic Breast General Gynecology Ophthalmology Orthopedic Vascular surgery Other Percutaneous core biopsy Excision of epidermoid cysts, lipoma, basal cell carcinoma, hydrocele aspiration Colposcopy, Endometrial biopsy, Insertion of intrauterine device Excision, biopsy of eyelid, e.g. chalazion, Laser iridotomy, Intravitreal injections Excision of ingrown toe nail, Intra-articular injection, carpal tunnel surgery Varicose vein injection, sclerotherapy, laser treatment or radiofrequency ablation Liver, renal and bone marrow biopsy, Vasectomy, Endoscopy via natural orifices, e.g. cystoscopy
8 Sterile instruments + aseptic technique Skin cancer excised Intravitreal injection
9 Minor Procedure room
10 Local Anesthetic
11
12 Patient Monitoring Equipment
13 The Empire of Light
14
15 Palpebral fissure
16
17 Eyelid Anatomy
18 Eyelid Glands: Zeis, Moll and Meibomian
19 Meibomian Glands Largest sebaceous glands (oil-secreting) 25 glands in upper eyelid 20 glands in lower eyelid Originate in the tarsus & empty onto lid margin
20 Orbital Fat Pads
21 Tendons and Muscles of the Eyelids
22 Upper Eyelid Retractor is Levator Palpebrae Superioris Levator aponeurosis is a pearly-white fibrous tissue that attaches the LPS to the tarsal plate Mueller s muscle is a smooth muscle with sympathetic innervation. Contributes 1-2mm eyelid elevation
23 Lower Eyelid Retractor/Capsulo Palpebral Fascia
24 Lacrimal System
25 Included in the ocular adnexa are all but one of the following: a) lacrimal apparatus b) glands of Moll, Zeis and Meibomian c) retina d) tarsal plate of eyelids
26 The Married Priest
27 What to expect? Review of medical and vision history. Testing of: visual acuity & refraction, pupillary reactions, cover test, visual field and intraocular pressure. Slit lamp exam to evaluate the front of the eye & eye lids. Dilated retinal exam.
28 Chalazion: constipated Meibomian gland
29 Completed their Initial Eye Examination Minor Surgery Instructions Ask your physician if you can stop taking blood thinners: Coumadin, Lovenox, Aspirin, etc. Avoid Aspirin, Ibuprofen, Ecotrin, Bufferin or Alka-Seltzer for 2 weeks before surgery because they thin the blood. Do not take Vitamin E or Alcohol two weeks prior to surgery. Take your routine medications, as usual prior to surgery. Eat and drink lightly. Do not wear make-up or fingernail polish. Wear comfortable clothing with a shirt/blouse which buttons up the front. Bring a companion who will drive you home.
30 Day of Surgery Eaten light meal? Taken routine meds? Someone to drive you home? No blood thinners? Visit the bathroom before surgery? Consented & operative eye is marked? Vital Signs Stable? Complete Surgical Safety Checklist?
31 Prepping the patient s eye
32 Local anesthetic BP blade holder, #11 blade Chalazion clamp Chalazion spoon/curette.3 forceps Blunt Wescott scissors Cautery, Q tips, 4x4 s Surgical drape
33 I & D of Chalazion
34 Incision & Drainage of Chalazion
35 Phone Call Post Op Day 1 How are you doing today? Is your pain manageable? Any swelling? Any issues with bleeding? Any questions I can answer for you?
36 The levator aponeurosis attaches to the upper eyelid at: a) Whitnall s tubercle b) Lockwood s ligament c) tarsal plate
37 La Misericorde
38 Ptosis: drooping eyelid
39
40 Had their Complete Eye Examination Minor Surgery Instructions Ask your physician if you can stop taking blood thinners: Coumadin, Lovenox, Aspirin, etc. Avoid Aspirin, Ibuprofen, Ecotrin, Bufferin or Alka-Seltzer for 2 weeks before surgery because they thin the blood. Do not take Vitamin E or Alcohol two weeks prior to surgery. Take your routine medications, as usual prior to surgery. Eat and drink lightly. Do not wear make-up or fingernail polish. Wear comfortable clothing with a shirt/blouse which buttons up the front. Bring a companion who will drive you home.
41 Day of Surgery Eaten light meal? Taken routine meds? Someone to drive you home? No blood thinners? Visit the bathroom before surgery? Consented & operative eye is marked? Vital Signs Stable? Complete Surgical Safety Checklist?
42 Ptosis surgery
43 Ptosis surgery Skin incised Septum opened to LA
44 Ptosis surgery Fat pad above LA Disinserted LA grasped by forcep
45 Ptosis surgery
46 After Ptosis Care Cold compresses 20 minutes on then off 20 minutes for first hours Use of antibiotic ointment to incision tid Rx for Percocet (narcotic pain med), if Tylenol does not relieve discomfort Do not use Ibuprofen or Aspirincontaining products If discomfort persists or you have any questions, please call the doctor
47 Phone Call Post Op Day 1 How are you doing today? Is your pain manageable? Any swelling? Any issues with bleeding? Any questions I can answer for you?
48 The human condition
49 Ectropion Horizontal lid laxity stretching of medial and lateral canthal tendons Both lower eyelids do NOT touch bottom margin of cornea Eyelids do not close properly Lacrimal tear does not pass into lacrimal drainage system
50 Had their Complete Eye Examination Minor Surgery Instructions Ask your physician if you can stop taking blood thinners: Coumadin, Lovenox, Aspirin, etc. Avoid Aspirin, Ibuprofen, Ecotrin, Bufferin or Alka-Seltzer for 2 weeks before surgery because they thin the blood. Do not take Vitamin E or Alcohol two weeks prior to surgery. Take your routine medications, as usual prior to surgery. Eat and drink lightly. Do not wear make-up or fingernail polish. Wear comfortable clothing with a shirt/blouse which buttons up the front. Bring a companion who will drive you home.
51 Day of Surgery Eaten light meal? Taken routine meds? Someone to drive you home? No blood thinners? Visited the bathroom before surgery? Consented & operative eye is marked? Vital Signs Stable? Completion of Surgical Safety Checklist?
52 Lateral Tarsal Strip
53 Before and After Lateral Tarsal Strip
54 Phone Call Post Op Day 1 How are you doing today? Is your pain manageable? Any swelling? Any issues with bleeding? Any questions I can answer for you?
55 A Lateral Tarsal Strip surgery is used to correct: a) punctal stenosis b) obstructed Meibomian gland c) lateral canthal tendon laxity d) esotropia
56 Entropion Inward turning of the eyelid margin Constant rubbing of the cornea Foreign body sensation, redness, tearing and discharge
57 Had their Complete Eye Examination Minor Surgery Instructions Ask your physician if you can stop taking blood thinners: Coumadin, Lovenox, Aspirin, etc. Avoid Aspirin, Ibuprofen, Ecotrin, Bufferin or Alka-Seltzer for 2 weeks before surgery because they thin the blood. Do not take Vitamin E or Alcohol two weeks prior to surgery. Take your routine medications, as usual prior to surgery. Eat and drink lightly. Do not wear make-up or fingernail polish. Wear comfortable clothing with a shirt/blouse which buttons up the front. Bring a companion who will drive you home.
58 Day of Surgery Eaten light meal? Taken routine meds? Someone to drive you home? No blood thinners? Visited the bathroom before surgery? Consented & operative eye is marked? Vital Signs Stable? Completion of Surgical Safety Checklist?
59 Reattach Capsulo palpebral fascia (retractors) to lower eyelid tarsal plate Silk traction suture Orbital septum opened, forceps to edge of detached retractors
60 Forceps holding detached retractors
61 Retractors reattached to lower edge of tarsal plate
62 4-0 Vicryl suture to periosteum for LTS repair
63 6-0 fast absorbing suture to close & 1 week post-op
64 Phone Call Post Op Day 1 How are you doing today? Is your pain manageable? Any swelling? Any issues with bleeding? Any questions I can answer for you?
65 The Beautiful Relations
66 Epiphora: excessive watering
67 Punctal stenosis Punctal scarring
68 Punctum is not draining properly
69 Had their Complete Eye Examination Minor Surgery Instructions Ask your physician if you can stop taking blood thinners: Coumadin, Lovenox, Aspirin, etc. Avoid Aspirin, Ibuprofen, Ecotrin, Bufferin or Alka-Seltzer for 2 weeks before surgery because they thin the blood. Do not take Vitamin E or Alcohol two weeks prior to surgery. Take your routine medications, as usual prior to surgery. Eat and drink lightly. Do not wear make-up or fingernail polish. Wear comfortable clothing with a shirt/blouse which buttons up the front. Bring a companion who will drive you home.
70 Day of Surgery Eaten light meal? Taken routine meds? Someone to drive you home? No blood thinners? Visited the bathroom before surgery? Consented & operative eye is marked? Vital Signs Stable? Completion of Surgical Safety Checklist?
71 3 Snip Punctoplasty
72 Silicone Stent & Worst Pigtail Probe
73 Pigtail probe inserted & 5-0 prolene suture placed
74 Silicone stent is thread onto the suture
75
76 Phone Call Post Op Day 1 How are you doing today? Is your pain manageable? Any swelling? Any issues with bleeding? Any questions I can answer for you?
77 Patients with excessive tearing and blurry vision may have: a) a cataract b) entropion c) punctal stenosis d) b & c
78 The Art of Living
79 Bell s Palsy
80 In addition to tension and inability to control one side of the face, common symptoms of Bell's palsy may include: Numbness on one side of the face Twitching of facial muscles Dryness of mouth and eye Excessive tearing in one eye Drooling Difficulty eating and drinking Pain around jaw/behind the ear Last 3-6 months, with/without tx Actor Joe Mategna
81 Gold Weight Placement
82
83 Had their Complete Eye Examination Minor Surgery Instructions Ask your physician if you can stop taking blood thinners: Coumadin, Lovenox, Aspirin, etc. Avoid Aspirin, Ibuprofen, Ecotrin, Bufferin or Alka-Seltzer for 2 weeks before surgery because they thin the blood. Do not take Vitamin E or Alcohol two weeks prior to surgery. Take your routine medications, as usual prior to surgery. Eat and drink lightly. Do not wear make-up or fingernail polish. Wear comfortable clothing with a shirt/blouse which buttons up the front. Bring a companion who will drive you home.
84 Day of Surgery Eaten light meal? Taken routine meds? Someone to drive you home? No blood thinners? Visited the bathroom before surgery? Consented & operative eye is marked? Vital Signs Stable? Completion of Surgical Safety Checklist?
85 Placement of Gold weight
86 Gold weight sutured & eyelid incision closed
87 Post Gold Weight Placement
88 Phone Call Post Op Day 1 How are you doing today? Is your pain manageable? Any swelling? Any issues with bleeding? Any questions I can answer for you?
89 Questions?
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