Guidelines for Pre-operative, Operative and Post operative precautions for Eye surgery
PRE-OPERATIVE PRECAUTIONS
Preoperative
General Exam :
Thorough checkup (Physician's referral)
Investigations
BP - At least 3-4 readings at different timing.
ECG - (especially of cardiac and hypertensive cases).
Haemogram
Urine (R/M, Albumin)
Check up for systemic illness
Diabetes
Chronic Pulmonary Conditions (COPD)
Hypertension & Cardio vascular Condition
Renal condition etc.
Ocular Examination
- Chief complaints and History of the problem. Complete ophthalmic examination
- Intraocular pressure
- Syringing - Not to be done on day of surgery
- Adnexal infections present to be treated with systemic antibiotics.
- Lid conditions & Sac related such as entropion, trichiasis, and Daryocystitis to be treated first.
- Intraocular surgery to be delayed by
- at least three weeks after these surgeries.
Keratometry
- To be calibrated for each observer
- To be calibrated after 20 cases for single observer
- Calibration at 45 D/7.5 mm Horizontal/Vertical
- Adjust eye piece to make mires coincide
Biometry
- Calibration before days use
- Test Block 14.5 mm (to check with company)
- Default settings to be used unless indicated
- Formula 22-24mm SRK-T or SRK-II
- < 22mm H offer Q
- >24 mm Holladay-l
- If the above are not available SRK-T in all patients
- A scan to be repeated if reading of Axial length vary by over 0.3 mm
- Biometry to be repeated completely if variation in IOL power is more than 1 Dioptre
- IOL to be correlated with refraction in contra lateral eye whenever possible.
OPERATION THEATRE PREPARATION
- Preoperative antibiotic drops for 24 Hrs.
- Bath for patients/ Head wash/Face wash
- Shaving (if possible)
Cleaning & draping
- Spirit and betadine from inwards outwards at least two times.
- Special note of eye brow/medial canthus area/nasal area
- Draping to isolate the eye. Steridrape to be
- used. (Scurgiwear / Romson's)
- Eye to be washed with BSS and Betadine 5%
Surgical scrubbing
- To proceed in a methodical manner from distal to proximal
- Hands/Palms/fingers/ Medial, lateral, dorsal, ventral aspects.
- Nail beds to be scrubbed with brush.
- Fore arm-Medial, lateral, anterior, posterior up to beyond elbow.
- Scrubbing from distal to proxima.
- Hands always above waist and elevated so that water drain away from hand,
Pre-opeartive, Operative Precautions
Preoperative antibiotic drops for 24 Hrs.
Bath for patients/ Head wash/Face wash.
Special note of eye brow/medial canthus area/nasal area.
Eye to be washed with BSS and Betadine 5%.
Sharps - Keratomes/blades/needle not to be reused unless sterilization procedure undertaken.
Intraocular instruments and canulas not be reused if possible unless properly sterilized Disposables wherever possible.
All Doctors and staff (Medical & Paramedical) should receive formal training in Biomedical waste Management.
OT to be washed /scrubbed before use and surfaces carbolized.
A drop of Beta-dine before starting the surgery.
Intra-operative Precautions
A drop of Beta-dine before starting the surgery.
Minimal handling of tissues
Instruments used for extra ocular manipulation not to be used inside eye
No wick left into anterior chamber- uvea/capsule/vitreous and complete removal and formation of anterior chamber with irrigating fluid/Air
No foreign material to be left in surgical area.
POST OPERATIVE
- Sub-conjunctival Antibiotics, single Drops of 5% Betadine in the conjunctivital Sac after completion of surgery.
- Systemic antibiotics only if adnexal infections present.
- Topical antibiotics to be given post operatively with anti-inflammatory- steroidal/non steroidal agents.
- Dilating drops once daily to keep pupil mobile.
- Personal hygiene to be emphasized.
- Avoid dust, smoke and sunlight.
- Wear protective dark glasses outdoors
- Routine weekly/ if necessary, more frequently postoperative visits should be ensured.
- Frequent instillation of Eye drops to be ensured.
Emergency Consultation
Excessive pain & Redness.
Watering/discharge
Sudden Blurring of vision/Decreased or loss of vision
Floaters/Flashes
Excessive photo phobia
Post Operative Precautions
- Sub-conjunctival Antibiotics, single Drops of 5% Betadine in the conjunctivital Sac after completion of surgery.
- Systemic antibiotics only if adnexal infections present.
- Topical antibiotics to be given post operatively with anti-inflammatory- steroidal/non steroidal agents.
- Personal hygiene to be emphasized.
- Avoid dust, smoke and sunlight.
- Wear protective dark glasses outdoors.
- Routine weekly/ if necessary, more frequently postoperative visits should be ensured.
- Frequent instillation of Eye drops to be ensured.
- Dilating drops once daily to keep pupil mobile.
Operation theatre Layout
