muscle hook
Beaver handle
Cannulas (23 gauge, 30 gauge)
Box 2.27 Enucleation Instrument Set
Enucleation scissors (strong, curved)
Kelly hemostat (curved)
Mosquito hemostats (curved)
Barraquer eyelid speculum
Tenotomy scissors
Fine‐tip needle holder
Castroviejo needle holder
Enucleation spoon
Graefe locking forceps
Utility forceps
Jaeger lid plate
Bishop–Harmon forceps
Box 2.28 Eye Utility Instrument Set
Adson forceps
#3 scalpel blade handle
Backhaus towel clamps (4 small)
Small straight hemostats (2)
Small curved hemostats (2)
Small basin
Small needle holder
Mayo scissors
3 × 3 nonwoven gauze sponges (10)
Instrument Sterilization
It is the hospital's responsibility to ensure that all personnel involved in the central sterilizing services department have been well educated and trained to effectively clean and disinfect the delicate instrumentation. To implement best practices, a standard operating protocol should be developed for ophthalmic instrument cleaning, processing, and preventive maintenance. As a reminder, all standard operating protocols should be reassessed annually and updated, if necessary, to reflect the most current evidence‐based guidelines. Refer to the manufacturer's recommended instructions for the instruments, cleaning agent, and sterilizer. Failure to comply with the instructions as indicated will weaken the effectiveness of the cleaning procedure. Gloves are required to be worn when handling instrumentation. A new pair should be donned whenever transitioning from handling used instruments to clean instruments. It is recommended that soiled instruments begin soaking in a basin immediately post‐procedure to soften organic material prior to manual or mechanical cleaning. Instruments should be submerged in tepid water and an enzymatic cleaning detergent solution. Refer to the manufacturer’s instructions for the instruments for the type of water preferred and an approved enzymatic cleaner. Avoid mixing regular surgical instruments with ophthalmic instrumentation due to their fragility. Soft bristled brushes can be used when manually cleaning instruments. Flush lumens and cannulas with a 20‐cc syringe filled with distilled water at least three times. Without overlapping, the instruments should be placed back into their respective cases, together with the silicone dividers for protection during the mechanical cleaning process. All hinged instruments must be fully opened before transfer to the ultrasonic cleaner. After the clean and rinse cycles are completed, the instruments should be dried and lubricated as directed by the manufacturer's instructions. Instruments should be inspected after each cleaning process leading up to packaging. Instruments can be placed back into the metal instrument cassette once fully dry. Cassettes can be packaged in an appropriately sized sterilization wrap according to the size of the cassette. Paper/plastic sterilization pouches are acceptable forms of packaging for loose, lightweight instruments, as long as all excess air is removed before the pouch is firmly sealed. Remember to include a chemical indicator strip on the inside and a piece of chemical indicator tape on the outside of all packaged items to confirm that sterilization parameters have been successfully met both internally and externally. Some newer sterilization pouches are equipped with their own internal and external indicators printed on the pouch. Be sure to double check that both indicators are present before packaging in case of unannounced inventory changes due to backordered items or switching of manufacturers.
Intraocular Surgery
The patient is placed in dorsal recumbency with the forelimbs extended caudally. An Olympic U‐shaped Vac‐Pac (Natus Medical Inc., San Carlos, CA) will conform to the patient's head using vacuum pressure to immobilize the patient's head for the duration of surgery. Towels, sandbags, and tape can also be used in addition to or in place of the U‐shaped Vac‐Pac. Indications for intraocular surgery include conjunctival grafting, laceration repairs, and foreign body removal. The instruments used are listed in Box 2.29.
Box 2.29 Instrumentation and Supplies for Intraocular Surgery
Intraocular set
Eye utility pack
Operating microscope
Sterile microscope drape
Clear adhesive patient drape
Table cover
Beaver 6400 mini‐blade (#64)
Angled crescent knife
Weck‐Cel® eye spears
7‐0 to 10‐0 braided absorbable suture
Disposable cannula 25 gauge (2)
3 ml syringe
1 ml syringe (2)
Dental cotton rolls
Included at the sugeon’s discretion:BSS® (balanced salt solution) sterile irrigating solution, 15 ml (Alcon Laboratories, Inc., Fort Worth, TX)Proparacaine hydrochloride ophthalmic solutionVET BioSISt™ (Smiths‐Surgivet®, Dublin, OH)ACeLL Vet (ACeLL Inc., Columbia, MD)1.8% or 2.2% Viscoelastic (an‐vision Inc., West Jordan, UT)
Extraocular Surgery
Extraocular procedures are typically performed in sternal recumbency. The patient's head must be stabilized for the duration of the procedure using a surgical vacuum pillow, sandbags, or rolled up surgical towels. Some patients may require additional support (e.g., securing adhesive tape to the table) to maintain optimal positioning. Indications include temporary tarsorrhaphy, eyelid laceration repair, and nictitating membrane laceration. Instruments and supplies are detailed in Boxes 2.30–2.32, respectively.
Box 2.30 Instruments and Supplies for Temporary Tarsorrhaphy
5 French red rubber feeding tube
Needle holder
Scalpel handle
3‐0 or 4‐0 non‐absorbable sutures
Box 2.31 Instruments and Supplies for Eyelid Laceration Repair
Eyelid set
Eye utility pack
Sterile