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An Urban Experience
is completed with a final flush with sterile saline. For surgery, the eye is draped with a sterile surgical cloth that has an adequate ‘window’. Both the use of re-usable drapes and of single use drapes is possible.
Adnexal Surgical Instrumentation and Suture Material
Commercially available ocular instruments are designed to minimize trauma to adnexal structures and facilitate handling of small needles and suture material. This author suggests that the basic eyelid ocular surgical pack should contain the following instruments:
• Barraquer eyelid speculum
• Hartman curved hemostatic mosquito forceps
• Knapp curved strabismus scissors
• Stevens straight tenotomy scissors
• Bishop-Harmon straight tissue forceps
• Small Derf needle holder
• Bard-Parker scalpel handle that accommodates a No. 15 Bard-Parker scalpel blade
• Berke-Jaeger eyelid plate
• Desmarres chalazion forceps
Ophthalmic instruments are delicate and should be cleaned with care, fine tips covered with plastic tip covers, and steam-autoclaved in a dedicated protective instrument tray.
Adnexal Suture Material
1) Nonabsorbable (silk, nylon, polypropylene, and braided polyester) and absorbable (polyglycolic acid, plyglyconate, and polydioxanone) suture material are commonly used in adnexal surgery. Of the commercially available options, this author prefers the use of suture material that is flexible and has less memory [e.g. silk (Ethicon) or braided nylon (Nurolon – Ethicon) versus monofilament nylon (Ethilon – Ethicon) for nonabsorbable suture and braided polyglactin 910 (Vicryl - Ethicon) versus monofilament polydioxanone (PDS II – Ethicon)] when performing eyelid surgery. Synthetic absorbable sutures have prolonged tensile strength and therefore can be used as a substitute for non-absorbable suture in many eyelid surgical procedures. Removal in 10-14 days is still recommended when using absorbable suture in the skin to minimize tissue reaction and expedite healing. Polyglactin 910 and polyglycolic cid are most commonly used in cutaneous and conjunctival eyelid tissues because they are softer, more pliant, and nonantigenic, thereby causing minimal tissue reactions. Coated polyglactin 910 decreases tissue drag, however knots must be secure to prevent premature loosening. Suture size is dependent on the procedure but typically ranges from 6-0 to 4-0 for most adnexal surgeries in canine and feline patients.
2) Needle type: Swaged needles result in smaller puncture holes though eyelid tissues, less tissue drag, and are recommended. Cutting or reverse cutting (1/4- 3/8 circle type) are preferred. Tapered needles should be avoided unless repairing a prolapsed gland of the third eyelid, in which case tapered needles can be a useful adjunct.
3) Other: Stents, made from pieces of I.V. tubing or sterilized rubber bands, help protect the eyelid skin and prevent premature dehiscence of sutures. Acknowledgements: The author graciously appreciates contributions to these lecture notes by fellow colleagues, especially Dr. Christine Heinrich.
Suggested References:
Giuliano EA. Regional anesthesia as an adjunct for eyelid surgery in dogs. Top Companion Anim Med. 2008 Feb;23(1):51-6. doi: 10.1053/j.ctsap.2007.12.007. Lackner PA Techniques for surgical correction of adnexal disease. Clin Tech Small Anim Pract. 2001 Feb;16(1):40-50.
Romkes G, Klopfleisch R, Eule JC. Evaluation of one- vs. two-layered closure after wedge excision of 43 eyelid tumors in dogs. Vet Ophthalmol. 2014 Jan;17(1):32- 40. doi: 10.1111/vop.12033. Epub 2013 Feb 13.
Moore CP, Constantinescu GM. Surgery of the adnexa. Vet Clin North Am Small Anim Pract. 1997 Sep;27(5):1011-66.
van der Woerdt A. Adnexal surgery in dogs and cats. Vet Ophthalmol. 2004 Sep- Oct;7(5):284-90.
White JS, Grundon RA, Hardman C, O’Reilly A, Stanley RG. Surgical management and outcome of lower eyelid entropion in 124 cats.Vet Ophthalmol. 2012 Jul;15(4):231-5. doi: 10.1111/j.1463-5224.2011.00974.x. Epub 2011 Nov 30.
Aquino SM. Surgery of the eyelids. Top Companion Anim Med. 2008 Feb;23(1):10-22. doi: 10.1053/j.ctsap.2007.12.003.
Jacobi S1, Stanley BJ, Petersen-Jones S, Dervisis N, Dominguez PA. Use of
an axial pattern flap and nictitans to reconstruct medial eyelids and canthus in
a dog. Vet Ophthalmol. 2008 Nov-Dec;11(6):395-400. doi: 10.1111/j.1463- 5224.2008.00664.x.
Donnelly KS, Pearce JW, Giuliano EA, Fry PR, Middleton JR. Surgical correction of congenital entropion in related Boer goat kids using a combination Hotz- Celsus and lateral eyelid wedge resection procedure. Vet Ophthalmol. 2014 Nov;17(6):443-7. doi: 10.1111/vop.12170. Epub 2014 Apr 30.
Read RA, Broun HC. Entropion correction in dogs and cats using a combination Hotz-Celsus and lateral eyelid wedge resection: results in 311 eyes. Vet Ophthalmol. 2007 Jan-Feb;10(1):6-11.
Williams DL, Kim JY Feline entropion: a case series of 50 affected animals (2003-2008). Vet Ophthalmol. 2009 Jul-Aug;12(4):221-6. doi: 10.1111/j.1463- 5224.2009.00705.x.
Maggs D, Miller P, and Ofri, R. Slatter’s Fundamentals of Veterinary Ophthalmology (5). Saint Louis, US: Saunders, 2013. ProQuest ebrary. Web. 27 June 2016.
Olver JM, Barnes JA Effective small-incision surgery for involutional lower eyelid entropion.
Ophthalmology. 2000 Nov;107(11):1982-8

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