Ophthalmic Surgical Assistant
What suture gauge is used to close corneal wounds?
10-0 nylon
Which is the larger gauge needle: 21 gauge or 23 gauge?
21 gauge
Which suture is "heavier" 4-0 or 10-0 nylon?
4-0
What generation of ocular fluoroquinolones is Vigamox?
4th
If using the timed method when scrubbing, how much time is given to each hand and arm?
5 minutes per hand and arm
What are two anti-metabolites that are used for glaucoma surgery that prevent the production of collagen that results in a scar?
5-FU and Mytomycin C
In corneal transplant surgery, what is the average diameter of the corneal donor button?
6.5 mm to 9 mm
What should pre-operative patients bring to their surgical appointment?
A list of medications and allergies
Before scrubbing, assistants should carefully clean the area under their nails with _
A nail file or nail pick
The eye drape should be placed snug but not tight around the eye for surgery. What could occur if the drape is positioned too tight?
A rise in intraocular pressure with possible vitreous loss during surgery
What test is performed pre-operatively to determine axial length?
A-scan
When wearing sterile gloves, hands must be kept _
Above the waist
To achieve rapid pupillary constriction during a surgical procedure, what is injected intraocularly?
Acetylcholine
Astigmatism is surgically corrected with what procedure?
Astigmatic Keratotomy (AK)
The wrapper of a sterile package must be opened _ from the body
Away
Additional instruments that are seldom used but occasionally required may remain on the _ table
Back
What type of cautery is commonly used in ophthalmic surgery?
Bipolar
Dermatochalasis can be treated using which surgical procedure?
Blepharoplasty
The most common cause of corrosion and pitting of instruments are _ and _
Blood and saline
What are the six methods commonly used for sterilizing ophthalmic instruments and materials?
Boiling, dry heat, autoclave, chemical disinfections, gas, and ultraviolet radiation
Why should artificial or acrylic nails not be worn by scrub personnel?
Both types of nails may harbor organisms or fungi
How does subconjunctival medication gain access to the eye?
By absorption into the blood stream
What device is commonly used in strabismus and retinal surgery for the measurement and marking?
Calipers
In an intracapsular cataract extraction, the entire lens and _ are removed from the eye
Capsule
The technique of tearing a circular opening in the anterior capsule in cataract surgery is called _
Capsulorhexis
When opening the outer wrap of a sterile pack of sutures, what must occur in order for the inner pack of sutures to remain sterile?
Care must be taken not to contaminate the inner pack by touching the inner pack with anything that is non-sterile
What is the advantage of cellulose sponges versus cotton swabs?
Cellulose sponges do not shed cotton fibers and are more absorbent
What instruments are used for chalazion excision?
Chalazion clamp, scalpel, forceps, curette, and scissors
What surgical procedure uses clamps and curettes to excise an obstruction of the meibomian gland of the eyelid?
Chalazion excision
How is the aseptic skin and eye preparation performed prior to ocular surgery?
Circular motion starting in the center and working outward
While keeping your hands inside the gown at the cuff, wait for the _ to tie gown before gloving.
Circulator
"Sutureless" cataract surgeries use what type of incisions?
Clear corneal incisions
What is the name of the technique where gloves are put on without being touched by the hand?
Closed technique
What is another name for a trabeculectomy?
Conjunctival bleb or filtering bleb
The Mayo stand should be arranged according to a _ pattern
Consistent
What is the result of the tip of the eye dropper touches the eye or eyelid?
Contaminated eye dropper tip
Used post-operatively, what class of ophthalmic preparations are used to inhibit inflammatory response and may also raise intraocular pressure?
Corticosteroids
What procedures destroy the ciliary body to achieve a decrease in aqueous humor production?
Cryoablation, cyclophotocoagulation, cyclocryotherapy
Name the first approved accommodating intraocular lens in the United States?
Crystalens
How should instruments be placed in a storage tray?
Curved and angle-tipped instruments should be placed with the tips down
Capsulorhexis refers to which step in cataract surgery?
Cutting or tearing open the anterior capsule of the lens
What category of drugs are these ophthalmic drops: tropicamide, cyclopentolate, and atropine?
Cycloplegics
What type of drop is used to prevent posterior synechiae?
Cycloplegics
How is an obstruction involving the lacrimal sac and nasolacrimal duct treated?
Dacryocystorhinostomy (DCR)
What is the surgical procedure that constructs new tear drainage from the lacrimal sac into the nose?
Dacryocystorhinostomy (DCR)
Indications for repair of an orbital floor fracture include_
Diplopia in primary or reading position, significant enophthalmos, or a large fracture
What term is used for the reduction of microorganisms on objects and surfaces?
Disinfection
In what direction should the patient look when topical corneal anesthetic is applied?
Down
An anterior chamber paracentesis is a procedure involving a needle to_ or _
Drain fluid to bring down intraocular pressure or draw fluid for analysis
What procedure permanently removes lashes from the eyelid margin by applying heat to the base of the hair follicle?
Electrolysis
Trichiasis can be treated by _ or _
Electrolysis or cryotherapy
What are two methods of permanently destroying hair follicles in cases of aberrant eye lashes?
Electrolysis, cryotherapy
What are 3 types of operative admissions for surgery?
Emergency, urgent, and elective
What is a post-operative complication that involves inflammation of the tissues inside the eye as well as intraocular infection?
Endophthalmitis
What is the difference between enucleation and evisceration?
Enucleation- the entire globe is removed Evisceration- the ocular contents are removed with the scleral shell preserved
What drug is used to relieve immediate serious allergic reactions?
Epinephrine
What solution is added to keep the pupil dilated during a procedure, reduce bleeding, and to assist with prolonging the duration of anesthesia?
Epinephrine
What gas can be used for the sterilization of delicate ophthalmic instruments?
Ethylene oxide gas
How often should instruments be lubricated?
Every 5 procedures and after every cleaning process
A conjunctival autograft could be used in which ophthalmic surgical procedure?
Excision of pterygium
What 3 factors are critical to the sterilization of instruments with moist heat?
Exposure time, temperature, and pressure
If a patient is scheduled for extraocular muscle surgery, what diagnostic tests are generally performed?
External photography and muscle balance measurements
Adjustable sutures are used for what surgical procedure?
Extraocular muscle surgery
What are the 3 basic components of a surgical needle?
Eye, body, and point
Ice packs should be used to control swelling after what type of procedures?
Eyelid and lacrimal
What instrument is used to hold the eyelids open?
Eyelid speculum
What type of instruments are the Lancaster and Barraquer?
Eyelid speculums
What is used to prevent the patient from squeezing their eyelids during surgery?
Facial nerve blocks
What are the five most common complications of office surgery?
Fainting, central nervous system stimulation, respiratory emergencies, allergic reactions, and drug reactions
What type of strip is used to determine if a wound is leaking?
Fluorescein
What form of fluorescein is preferred for use in the operating room to decrease the risk of contamination?
Fluorescein strips
What instruments may commonly be required in minor office surgery?
Forceps, scissors, needle holders, clamps, curettes, scalpels and blades, lacrimal instruments, and cannulas
How many sides are indicated when scrubbing the fingers, hands, and arms?
Four: Top, bottom, right, and left side
What part of the surgical gown is considered sterile?
Front of the gown from the chest to the level of the sterile field and the sleeves 2 inches above the elbow and down to the cuff
What tissue is transplanted during a penetrating corneal transplant surgery?
Full thickness cornea
What term is used for the bore size of hypodermic needles?
Gauge
A trabeculectomy is used to treat what condition of the eye?
Glaucoma
Patients with a bleb will experience foreign body or dry eye sensation following what type of surgery?
Glaucoma
What type of localized slightly hyperemic, elevated tender mass is caused by eyelashes, cotton fibers, or glove powder?
Granuloma
What is the purpose of forceps?
Grasp tissue, suture, and tying
After donning gown and gloves, gloves should be checked for what issue prior to handling the instruments or sterile materials?
Holes or tears
The following drugs: acetazolamide, glycerol, and isosorbide are of what classification?
Hyperosmotic
What drugs are used to shrink the vitreous body and reduce intraocular pressure by drawing fluid out of the tissues?
Hyperosmotics
What are the most common causes of corrosion in stainless steel instruments?
Inadequate cleaning and drying, over exposure to sterilizing solutions
What is the most common cause of corrosion of instruments?
Inadequate cleaning and drying. Particles or materials that remain on the surface following sterilization
The first steps in a maintenance program of instruments are _ and _
Inspection and evaluation
Ultrasonic cleaners remove foreign matter and all lubrication from instruments. What step should follow the ultrasonic cleaning process?
Instruments should be bathed in instrument milk
What is used to anesthetize the iris?
Intracameral anesthesia
What is the name of the procedure performed where a small portion of the iris is removed with scissors during surgery?
Iridectomy or Peripheral Iridectomy
The primary goal of intracameral anesthesia is to anesthetize what ocular structure?
Iris
Who introduced modern surgical aseptic techniques in the 19th century?
Joseph Lister
Name 3 types of ocular emergencies that may require surgical intervention
Lacerated globes and eyelids; intraocular foreign bodies; acute glaucoma; and, intraocular hemorrhage
What type of surgery requires probes and dilators to open obstructed canals?
Lacrimal
What is the name of the procedure where a small circular type hole is created in the iris with a laser?
Laser Iridotomy
The abbreviation LASIK stands for what procedure?
Laser in situ keratomileusis
What refractive technique utilizes a microkeratome?
Laser in situ keratomileusis (LASIK)
What surgical procedure is used in the treatment of angle-closure glaucoma?
Laser peripheral iridotomy
What is the procedure that uses an Argon laser to shrink areas of the trabecular meshwork?
Laser trabeculoplasty
What muscle is resected (shortened) to surgically correct ptosis?
Levator palpebrae superioris
What kind of disposable instrument wipes are recommended for cleaning microsurgical instruments?
Lint-free wipes
What is the term used to administer medications by injecting an anesthetic into the skin?
Local anesthetic
What are two basic types of needle holders?
Locking, non-locking
What may a physician use to increase visibility for an in-office procedure?
Loupe
What is the best way to inspect an instrument prior to sterilization?
Magnifying lens or loupe
What are vital signs?
Measurement of blood pressure, pulse, and respirations
What type of blade is used by the surgeon to make a clear corneal incision?
Microkeratome
What drugs cause the iris sphincter muscle to contract?
Miotics
What technique is often used to remove malignant tumors and/or growths from the eyelids?
Moh's technique
What is an advantage of using a suture that will not degrade or break apart over time?
More tensile strength/stronger suture. Less tissue inflammatory suture reactions as compared to absorbable sutures
What is a common error in preparing skin with an antiseptic solution?
Moving from clean to contaminated areas and back again
Under and over corrections are common after what type of surgery?
Muscle
Jameson, Von Graefe, and Stevens are what type instruments?
Muscle hooks
What drug dilates the pupil?
Mydriatic
What instrument is used to hold suture needles?
Needle holders
What antibiotic is most likely to create a hypersensitivity state and induce an allergic response?
Neomycin
What are the 4 main methods of infiltration anesthesia?
Nerve block, direct infiltration subcutaneously, retrobulbar anesthesia, and peribulbar
What is the recommended pH level for ophthalmic instrument cleaning solutions?
Neutral pH level (7.0-8.5)
What type of drug is used to reduce inflammation, prevent edema, reduce ocular pain, and generally does not increase intraocular pressure?
Non-steroidal anti-inflammatory drugs (NSAIDs)
What are 2 basic methods of gloving?
Open and closed
Surgical stainless steel and/or titanium are used in the creation of what instruments?
Ophthalmic surgical instruments
How is the sterile gown picked up during gowning?
Pick up the gown by the neckline/shoulders, lift straight up and hold away from body
What drug has a direct-acting miotic affect and may cause headaches?
Pilocarpine
Rust can be transferred to an instrument from another source. To detect if the actual instrument itself is rusting, a pencil eraser is used to remove the rust and check for _
Pitting
There are several types of absorbable sutures that are used in ocular sutures. Name one
Plain or chronic surgical gut Vicryl or Dexon PDS (polydioxanone) suture
What type of suture will not degrade or break apart over time?
Polypropylene (Prolene) Mersilene polyester fiber suture
Sterile liquids may be poured into a sterile cup or basin for use during the procedure. When the liquid has been poured, the edge of the cap is considered contaminated. What should happen to the remaining liquid?
Pour and utilize the whole container or discard the remaining liquid after pouring what is needed
What type of surgical gloves should be used for ophthalmic surgery?
Powderless or talc-free
What tray consists of antiseptic, irrigation solutions, gauze, applicators, and a syringe bulb?
Prep tray
What is a requisite of all intraocular solution?
Preservative free and sterile
When preparing a patient for surgery, when are vital signs taken, as well as when are dilating drops and sedatives administered?
Prior to surgery
When should the consent form for surgery be completed?
Prior to the procedure, before any medications are administered
Removal of a fibrovascular growth on the conjunctiva impinging on the cornea is called _
Pterygium
What instrument would be used to enlarge the punctum?
Punctal dilator
Tear duct irrigation is performed using what instruments?
Punctual dilator, syringe, and lacrimal cannula
A lacrimal set includes what instruments?
Punctun dilator, syringe, and blunt lacrimal cannula
What is the procedure that is used to "weaken" an extraocular muscle?
Recession
Phototherapeutic keratectomy (PTK) is used to correct what medical eye conditions?
Recurrent corneal erosions and superficial corneal scarring
A scleral buckle refers to which surgical procedure?
Repair of retinal detachment using a circumferential band to indent the sclera and choroid
What is the procedure that is used to "strengthen" an extraocular muscle?
Resection
A pneumatic retinopexy could be used to treat what ocular condition?
Retinal detachment
What injections are given behind the globe into the muscle cone in order to block the ciliary ganglion and nerves?
Retrobulbar injections
What is the name of the laser procedure similar to ALT (Argon Laser Trabeculoplasty) which utilizes a switched 530-nanometer laser?
SLT or Selective Laser Trabeculoplasty
What instrument is used to cut tissue and sutures?
Scissors
What is the name of circumferential band used to repair a retinal detachment?
Scleral buckle
What is a potentially serious complication of strabismus surgery?
Scleral perforation
What is considered surgical attire?
Scrub suit, head covering, masks, and shoe covers
Sterilization of the operator's or assistant's skin is called _
Scrubbing
What steps should be taken prior to sterilization to ensure cleanliness of instruments?
Scrupulous cleansing, careful inspection
Name 3 types of materials utilized in soft intraocular lenses that can be folded and inserted through a smaller incision
Silicone, hydrogels, and acrylic
What are the 3 basic types of cautery instruments?
Single tip cautery, bipolar, and grounded bovie
How should single use items be sterilized?
Single use items are meant to be used only one time and should not be sterilized after initial use
During intraocular lens implantation, what type of hook is used to rotate the IOL into place?
Sinskey
If the gauge number of a hypodermic needle is large, what is the diameter of the bore needle?
Small
Instrument "rust" may actually be a _
Stain
Microorganism contamination is prevented by maintaining sterility through _ _
Sterile technique
Immediately after use, a diamond blade should be rinsed with what type of solution?
Sterile water
What term is used for the elimination of all microorganisms from instruments?
Sterilization
A diamond blade with baked-on protein may be cleaned by inserting the retracted diamond blade into a wet _ _ and working it through incisions in the direction it is designed to cut
Styrofoam peanut
In what position is the patient placed during surgery?
Supine
What is an ectropion repair?
Surgical repositioning of a lower eyelid that is rolling outward from the surface of the globe
Objects and instruments that contain a reduced number of microorganisms from mechanical, chemical, or physical methods are referred to as _ _
Surgically clean
Where is the sterile zone confined?
Table top and waist level
What procedure involves suturing the upper eyelid to the lower eyelid?
Tarsorrhaphy
In strabismus surgery, the complete severing of the muscle or tendon is called a _
Tenotomy
What is another name for the tray stand that is closest to the operative site and instruments are set-up and ready for surgery?
The Mayo stand
What characteristic of the human cornea makes corneal transplantation possible?
The absence of blood vessels
A "lamellar corneal transplant" refers to what surgical procedure?
The anterior "half thickness" of the cornea is transplanted from donor to recipient
What is the name or role of the person in the operating room who coordinates the room activities, interfaces with the patient, and provides support and supplies to the scrubbed personnel?
The circulator
Who is responsible for tying the gown before gloving?
The circulator
Who is responsible for the preservation of asepsis or sterility measures in the operating room?
The entire operating team should monitor and report any type of potential break in sterility so that corrective action can be initiated
What is the proper technique to remove gowns and gloves at the end of a case?
The gown is removed before the gloves, by pulling downward from the shoulders with the sleeves turning inside-out as the gown and gloves are pulled off
You are working as a surgical scrub tech assistant and need to pass an instrument to the surgeon, such as scissors or forceps. What is the proper way to position and hand off the instrument to the surgeon?
The instrument is handed to the surgeon in the position that it is ready to be utilized. By handing off instruments in this manner, the surgeon does not have to reposition the instrument before use
A surgical gown is folded so the surgical scrub assistant can unfold the gown and put it on without touching the _ side
The outer side or sterile side
Name 2 types of sterile package delivery methods that may be utilized in the operating room by the circulating nurse
The peel back method. The hand held method (one example is the circulating nurse could put on a sterile glove to deliver the object to the back table or Mayo tray)
What is the purpose of hydrodissection during cataract extraction?
The separation of the cortical material from the capsule
If scrubbed personnel need to change positions during a procedure, how should they position themselves in order to maintain the integrity of the sterile field?
The should cross face-to-face or back-to-back. Circulating personnel should not walk between two sterile fields
What is the "infiltration method"?
The surgeon injects the anesthesia solution beneath the skin, beneath the conjunctiva, or into the Tenon's capsule
Who should a patient speak to if they are uncomfortable under the surgical drape?
The surgeon, anesthetist, or the nurse
What is the main advantage of using an absorbable suture?
The suture dissolves
What is a double armed suture?
There is a needle attached to each end of the suture
How are surgical specimens preserved for microscopic examination?
They are placed in specimen bottles containing formaldehyde
How do sterile persons pass one another?
They should pass face-to-face or back-to-back
Why is it recommended for surgical personnel to wear long sleeves in the operating room? This includes individuals who are not scrubbed in or assisting with sterile instrumentation
This type of clothing prevents shedding of skin from bear arms
During cataract surgery, how is the nucleus of the lens suctioned?
Through an opening in the tip of the ultrasonic hand-piece (phacoemulsification)
During vitrectomy, where are the sclerotomy incisions made?
Through the pars plana
What is the disadvantage of using an absorbable suture?
Tissue reaction or inflammation and less tensile strength in the suture as it breaks down
Why are microsurgical instruments separated during ultrasonic cleaning?
To avoid vibrations that may cause premature precision tip wear
What is the purpose of the "optic" portion of the IOL?
To focus light on the retina
What is the function of the "haptic" portion of the IOL?
To hold the lens in the center of the pupil
Why are the hands elevated above the elbow after scrubbing?
To keep the water from running down the arm and contaminating scrubbed areas
What is the purpose of using a viscoelastic substance during the placement of an IOL?
To minimize corneal endothelial damage
What is the most common use of the YAG laser?
To open the opacified posterior capsule after cataract surgery
What is the purpose of the subcutaneous infiltration of the local anesthesia?
To paralyze the orbicularis oculi muscle, which closes the eye
What is the function of ultraviolet filter on the operating room microscope?
To prevent prolonged and potentially damaging ultraviolet exposure to the macula
The purpose of hydrodelineation during cataract surgery is _
To separate the nucleus from the epinucleus
Less risk of complications due to anesthesia is a significant advantage of which type of ophthalmic anesthesia administration?
Topical
What is topical anesthesia?
Topical anesthesia is an anesthetic that is applied to the outside of the eye to numb the tissue
What are tetracaine and proparacaine?
Topical anesthetics
A surgical procedure that involves the removal of a portion of the trabeculum to improve outflow of fluid from the eye is called _
Trabeculectomy
What instruments have no teeth and are used to tie sutures?
Tying forceps
What is the most frequent complication strabismus surgery?
Under correction
What are the guidelines used to control the transmission of any infectious blood borne pathogens?
Universal precautions
Backs of gowns, including the wrap around gowns, are considered _
Unsterile
The edge of any container that holds sterile supplies is considered _
Unsterile
What are two ways of avoiding contamination of eye drops?
Use of small bottles or single use products. Avoid touching eye during administration
What are microsurgical instruments?
Very delicate instruments with fine tips
What is the name of the thick, gelatinous substance used in intraocular surgery to protect the corneal endothelium?
Viscoelastic
Which surgical procedure could be used to treat a diabetic patient with a non-clearing vitreous hemorrhage?
Vitrectomy
Surgical treatment of a macular hole would require which surgical techniques?
Vitrectomy, membrane peel, gas fluid exchange
What is a simple method for correcting entropion utilizing a cautery?
Ziegler cautery
What technique of refractive surgery does not require making a flap with a microkeratome?
Photorefractive Keratectomy (PRK)
Which scrub technique utilizes numbered brush strokes per designated area?
Anatomic
What are the 2 scrub methods?
Anatomical and timed
What are the 3 most common positions of intraocular lenses placed on the eye?
Anterior chamber, ciliary sulcus, and capsular bag
What laser procedure produces new channels to drain fluid within the trabecular meshwork?
Argon laser trabeculoplasty (ALT)
What is the term of the sterile technique followed in the operation room?
Asepsis
Proper sterilization of instruments; sterilization of the skin adjacent to the operative site; sterilization of the hands of both operator and assistant; and, the use of sterile solutions and ointments during and after the operation is called _ _
Aseptic technique
The attempt to prevent infection by the elimination of microorganisms is called _ _
Aseptic technique
What technique is used to eliminate microorganism contamination to prevent infection?
Aseptic technique
What is the abbreviation for phototherapeutic keratectomy?
PTK
What are common symptoms of raised intraocular pressure (IOP)?
Pain, redness, and corneal edema
What type of laser surgery aids in the reduction of severe vision loss from proliferative diabetic retinopathy?
Panretinal photocoagulation (PRP)
How is a temporary paralysis of the extraocular muscles achieved?
Paralysis is achieved through retrobulbar injections
Local anesthetics, mixed too far in advance of the surgical procedure, carry what primary risk?
Patient discomfort
When scheduling a patient for surgery, what information is needed for scheduling purposes?
Patient name, date of birth, type of insurance, contact information, procedure, anesthesia, operative eye, and length of time needed for the procedure
The abbreviation PKP stands for what procedure?
Penetrating keratoplasty
What type of anesthesia is given so that the anesthetic surrounds the soft tissue of the globe?
Peribulbular anesthesia
What is the procedure that uses ultrasound to remove a cataract?
Phacoemulsification
When prescribing medicine for the eye, what is the sig for twice a day?
bid
