Auer Ch 56 57 58 Eye

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conjunctival advancement pedicle graft

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guyton park eyelid speculum

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Function of orbicularis oculi muscle:

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close eyelids

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Innervation of orbicularis oculi:

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palpebral branch of facial nerve (VII)

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Muscles that open eyelids:

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levator anguli oculi, levator palpebrae superioris, frontalis, malaris, muller’s

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What is muller’s muscle associated with?

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Levator palpebrae superioris

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Innervation of levator anguli oculi:

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palpebral branch of facial nerve (VII)

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Innervation of levator palpebrae superioris:

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dorsal branch of oculomotor (III)

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Innervation of muller’s muscle:

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sympathetic

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Innervation of frontalis:

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palpebral branch of facial nerve (VII)

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Innervation of malaris:

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dorsal buccal branch of facial nerve (VII)

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Sensory innervation of upper eyelid:

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branches (supraorbital nerve, lacrimal nerve, infratrochlear nerve) of ophthalmic portion of trigemical nerve (V)

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Sensory innervation of lower eyelid:

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zygomaticofacial branch of the maxillary portion of the trigeminal nerve (V)

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Entropion:

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inward turning of eyelid

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Repair of entropion:

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temporary: everting vertical mattress suture permanent: Y to V plasty, modified Hotz-celsus

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Ectropion:

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out turning of eyelid

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Repair of ectropion:

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V to Y plasty

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Types of reconstructive blepharoplasty techniques:

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sliding skin flap, conjunctival advancement flap, full thickness eyelid graft, rhomboid graft flap, sliding z flap

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Indications for reconstructive blepharoplasty:

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extensive eyelid lacerations or closure of large defects after neoplasia removal

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Sensory innervation to 3rd eyelid:

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infratrochlear nerve

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Complications of 3rd eyelid resection:

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orbital fat prolapse, keratoconjunctivitis sicca, superficial keratitis

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Arterial supply to conjunctiva:

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anterior ciliary arteries, branches of ophthalmic artery

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Innervation of bulbar conjunctiva:

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long ciliary branch of ophthalmic portion of trigeminal (V)

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Innervation of superior palpebral conjunctiva:

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frontal and lamcrimal branches of ophthalmic portion of trigeminal (V)

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Innervation of inferior palpebral conjunctiva:

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lacrimal and infraorbital branch of maxillary portion of trigeminal (V)

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Vascular supply to sclera:

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anterior and posterior ciliary arteries from ophthalmic artery

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Sensory innervation of anterior sclera:

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long posterior ciliary nerve branch from ophthalmic nerve

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Sensory innervation of posterior sclera:

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short posterior ciliary nerve from cilary ganglion

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Layers of cornea:

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epithelium, stroma, descemet’s membrane, endothelium

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Innervation of cornea:

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long ciliary nerve

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Ocular hemostasis:

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wicking sponges, 2.5% phenylephrine on cotton applicator, 1:10,000 epinephrine on cotton applicator

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What is a superficial keratectomy?

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Surgical excision of a superficial layer of corneal tissue including epithelium and anterior stroma

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Indications for superficial keratectomy:

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Dermoids, infection, corneal malacia, superficial corneal abscess, corneal neoplasia

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Complications of superficial keratectomy:

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excessive neovascular response, scarring, infection, corneal perforation

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What is the depth of corneal suturing?

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80-90%

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What are conjunctival grafts?

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Transposition of a portion of conjunctival tissue to cover a corneal defect

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Types of conjunctival grafts:

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rotation pedicle graft, advancement pedicle graft, tarsoconjunctival grafts, bipedicle graft, bridge graft, hood graft, free island graft, 360 degree graft

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Indication for rotation pedicle conjunctival graft:

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centrally located corneal defects

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Indication for advancement pedicle conjunctival graft:

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corneal defects closer to the limbus

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Indication for bipedicle or bridge conjunctival grafts:

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linear and large abaxial located corneal defects

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Indication for hood conjunctival graft:

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large corneal defect closer to limbus

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Disadvantage of free island and 360 degree conjunctival grafts:

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absence of blood supply, preclude vision, prevent visualization of globe

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Complications of conjunctival grafts:

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dehiscence, infection, effects on vision

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When is trimming of the conjunctival graft performed?

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6-8 weeks post-op

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Indication for sliding lamellar keratoplasty:

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repair of deep corneal defect where surrounding cornea is healthy and clear axial cornea is desired

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Indication for corneal grafting:

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deep corneal stromal abscess, corneal endothelial disease, large corneal perforation

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Donor for corneal grafting:

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harvested fresh or frozen corneas

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Types of corneal grafts:

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penetrating keratoplasty, posterior lamellar keratoplasty, deep lamellar endothelial keratoplasty