Ophthalmology

Instruments

Nikhil Gotmare,
Resident Ophthalmologist,
Guru Nanak eye centre,
Maulana Azad medical college,
New Delhi

Ophthalmology Instruments@eyeamnikhil 1
Ophthalmology
Instruments

Nikhil Gotmare,
Resident Ophthalmologist,
Guru Nanak eye centre,
Maulana Azad medical college,
New Delhi

Ophthalmology Instruments@eyeamnikhil 1
OPHTHALMOLOGY
INSTRUMENTS

VARUN MALPANI
SETH GS MEDICAL COLLEGE, MUMBAI
Universal metallic eye speculum Wire speculum

LID SPECULUMS

Used to keep the lids apart during:

Intraocular operations such as cataract
surgery, glaucoma surgery and
keratoplasty
Enucleation and evisceration operation
Cauterization of corneal ulcer
Removal of conjunctival and corneal
foreign body
PLAIN FORCEPS & TOOTHED FORCEPS

It is a simple forcep without any teeth.

Used to hold conjunctiva during any
surgical procedure.
To tie sutures.
To hold skin during eyelid surgery.
 GLOBE FIXATION FORCEPS
_

It is applied near the limbus to hold the

conjunctiva and episcleral tissue
together.
Used to fix eyeball during operations on
the eyeball.
To hold eyeball during forced-duction
test.
 •

SUPERIOR RECTUS HOLDING FORCEPS

It is a toothed forceps with S-shaped

double curve near the tip.
Used to hold superior rectus muscle
while passing a bridle suture under it
To stabilize the eyeball during any
operation.
 COLIBRI FORCEPS

Used to hold the cornea or scleral edge

of incision for suturing during cataract,
glaucoma, repair of corneal and for
scleral tears and keratoplasty
operations.
 IRIS FORCEPS

These are small and delicate forceps

having fine 1 x 2 teeth on the inner side
of the limbs. These are also available in
various shapes and designs.
These are used to catch the iris for the
purpose of iridectomy during operations
for cataract, glaucoma, optical
iridectomy and excision for iris prolapse,
tumours and entangled foreign bodies.
Not used nowadays.
In the era of intracapsular cataract
extraction (ICCE), it was used to hold the
lens capsule during capsule forceps
method of lens delivery in intracapsular
cataract extraction and to grasp and
remove the capsular remnants after
accidental extracapsular lens extraction.
 ARTERY FORCEPS

To catch the bleeding vessels during

operations of the lids and lacrimal sac.
To hold the skin and muscle stay
sutures.
To hold small 'pea-nut' gauze pellets for
blunt dissection in lacrimal sac surgery
and other extraocular surgery.
To hold gauze pieces while packing the
socket after enucleation or exenteration
operation.
 MUSCLE(STRABISMUS) HOOK

It is used to engage the extraocular

muscles during surgery for squint,
enucleation, and retinal detachment.
In the absence of lens expressor, it may
be used in its place.
It is a fork-like instrument with the
terminals bent inward.
It is used to retract the skin during
lacrimal sac and lid surgery.
SELF-RETAINING LACRIMAL WOUND
RETRACTOR

It is made up of two limbs with three

curved pins on each for engaging
the edges of the skin incision.
The limbs are kept in a retracted
position with the help of a fixing
screw.
It is used to retract the skin during
surgery on the lacrimal sac.
These are available in various sizes with
straight or curved tips, in different
shapes and may be with or without
locking system.
The jaws of the needle holder are finely
serrated to hold the fine needles firmly.
Spring type needle holders are used for
passing sutures in the conjunctiva,
cornea, sclera and extraocular muscles.
These are large needle holders and all
are of similar type with slight model
differences.
The upper shank of these needle
holders has a flat and broad plate to
accommodate the surgeon's thumb.
These are available with and without
locking device.
These are very commonly used in lid
surgery and also for passing superior
rectus suture.
 CASTROVIEJO CALLIPER

It is used to take measurements during

squint, ptosis, retinal detachment and
pars plana vitrectomy surgery.
It is also used to measure corneal
diameter and visible horizontal iris
diameter.
 KERATOME

Keratome has a thin diamond-shaped

blade with a sharp apex and two cutting
edges.
Keratomes are used to make valvular
corneal incisions for entry into the
anterior chamber for all modern
techniques of cataract extraction viz,
phacoemulsi£ication, SICS and even
conventional ECCE and other intraocu1ar
surgeries, e.g. iridectomies and
paracentesis.
 15º SIDE PORT ENTRY BLADE

It is a fine straight knife with a sharp

pointed tip and cutting edge on one
side.
It is used to make a small valvular clear
corneal incision in phacoemulsification
and other intraocular surgeries including
pars plana vitrectomy.
 CRESCENT KNIFE
It is used
To make tunnel incision in the sclera and
cornea for phacoemulsification, manual
small incision cataract surgery (SICS),
and suture less trabeculectomy.
To separate the conjunctiva and
subconjunctival tissue from the sclera
and limbus when limbal-based flap is
made for trabeculectomy surgery.
It can also be used to separate partial
thickness lamellae of sclera during
trabeculectomy.
To separate pterygium head or limbal
dermoid from the underlying corneal
lamellae.
 CYSTOTOME

Disposable cystotome is prepared by

bending the disposable 26 gauge or 30
gauge hypodermic needle.
It is used for doing anterior capsulotomy
or capsulorhexis during extracapsular
cataract extraction.
 CORNEAL SCISSORS

These are used to enlarge corneal or

corneoscleral incision for conventional
intra capsular and extracapsular cataract
extraction techniques of cataract
surgery.
To enlarge corneal incision in
keratoplasty operation.
To cut the scleral and trabecular tissue
in trabeculectomy.
It can also be used for cutting and
undermining conjunctiva in various
operations.
Vannas Scissors

Corneal Scissors

VANNAS SCISSORS

These are used for cutting anterior

capsule of the lens in extracapsular
surgery and for cutting 10- 0 nylon
sutures.
For cutting inner scleral flap in
trabeculectomy.
For doing pupillary sphincterotomy.
For performing iridectomy.
For cutting pupillary membrane.
 ENUCLEATION SCISSORS

They are large, stout and strong

scissors having curved sharp blades
with blunt ends.
They are used to cut the optic nerve
during enucleation operation.
 ENUCLEATION SPATULA

It consists of a small but stout

rectangular blade with slightly convex
surface and blunt edges attached to a
handle.
To separate out the uveal tissue from
the sclera during evisceration operation.
 ENTROPION CLAMP

It is used in lid surgery, e.g. entropion,

and ectropion corrections. It protects the
eyeball, supports the lid tissue and
provides haemostasis during surgery.

Advantage:
It is a self- retaining instrument and
does not need an assistant to hold.
Disadvantages:
Operative field is less.
Pressure necrosis can occur if fitted
Lightly.
 PTOSIS CLAMP

It is like a forceps with J-shaped ends

having internal serrations.
The clamp has a locking mechanism.
To hold levator palpebrae superioris
muscle during ptosis surgery.
 SINSKEY HOOK OR IOL DIALER

It is used to dial the PMMA non-foldable

IOL for proper positioning in the capsular
bag or ciliary sulcus.
It can also be used to manipulate the
nucleus in phacoemulsification surgery.
Nucleus manipulation may be in the
form of nucleus rotation in the capsular
bag, cracking of the nucleus and feeding
of the nuclear fragments into the phaco
tip.
 MCPHERSON FORCEPS

These are fine forceps with bent limbs.

Uses:
To hold the superior haptic of IOL
during its placement.
To tear-off the anterior capsular flap
in ECCE.
Can be used for suture tying.
 WIRE VECTIS

It is a wire loop attached to a metallic

handle.
It is used to remove subluxated lens and
anteriorly dislocated lens in ICCE
technique and the nucleus in ECCE
technique.
TWO WAY IRRIGATION ASPIRATION
CANNULA
It has two openings, one on tip of
cannula for irrigation and one on anterior
surface for aspiration of lens matter or
other contents.
At its posterior end, there is one hub
anterior to that of hypodermic needle for
attachment to TV line for irrigation.
At the other side, there is a cannula with
a plastic tubing and another hub for
attachment to a syringe or other source
of vacuum for aspiration.
Used:
For irrigation and aspiration of the
lens matter in extracapsular cataract
extraction.
Aspiration of hyphaema.
 IRIS REPOSITOR
-

It consists of a delicate, flat, malleable,

straight or bent blade with blunt edges
and tip attached to a handle.
Uses:
To reposit the iris in the anterior
chamber in any intraocular surgery.
To break synechiae at the pupillary
margin.
 IOL HOLDING FORCEPS

It is a spring action forceps with short,

blunt and curved blade shaving smooth
edges and tips with platform (no teeth or
serrations).
Use:
To hold optic of non-foldable PMMA
IOL during implantation.
 CHOPPER

The inner edge of the bent tip is cutting

and may have different angles.
Use:
It is used to split or chop the nucleus
into smaller pieces and also for
nuclear manipulation in
phacoemulsification surgery.
 CHALAZION SCOOP

It has a small cup with sharp margins

attached to a narrow handle.
Use:
To scoop out contents of the
chalazion during incision and
curettage.
 BONE PUNCH

It consists of a stout spring handle and

two blades attached at right angle.
The upper blade has a small hole with a
sharp cutting edge. The lower blade has
a cup-like depression.
Use:
It is used to enlarge the bony
opening during DCR operation by
punching the bone from margins of
the opening.
Iris Repositor

Sinskey Hook/IOL Dialer

Muscle hook
IOL holding forceps
=
BLADES
SCLEROCORNEAL SPLITTER (CRESCENT KNIFE)

Identification: It has a thin crescentic blade, at the end of a neck and attached to
a polycarbonate handle. The cutting edge blade may be beveled-up or beveled-down.
The blade has a forward angulation of 45°for better and parallel movement during
dissection.
It is available as a disposable blade in presterile pack. It may be reused for 3 4 times
after ETO sterilization.
Uses
Used to make sclerocorneal tunnel in manual SICS or phacoemulsification.
Used for lamellar dissection of the cornea in lamellar keratoplasty.

ANGULAR KERATOME

Identification: It has a thin triangular blade, at the end of a neck and attached to
a polycarbonate handle. The cutting edge blade may be beveled-up or beveled-down.
The blade has a forward angulation of 45° for better and parallel movement during
dissection. The width of the blade may be 2.8 3.0 mm diameter (for phacoemulsification).
or 4.5 5.5 mm for manual SICS

It is also available as a disposable blade in presterile pack. It is advisable not to reuse

these disposable blades.
Uses
Used to enter into the anterior chamber after making sclerocorneal tunnel in
manual SICS or phacoemulsification.
It may be used directly for making corneal section in phacoemulsification.
4.5 5.5 mm diameter keratome is used to enlarge the tunnel.

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MVR or V-Lance blades

Identification: It is a fine straight instrument with triangular knife at

distal end having cutting edges on both the sides
Use: It is used for making side port entry at the limbus.

SIDE-PORT BLADE

Identification: It has a thin, long straight blade, at the end of a neck and attached to a
polycarbonate handle. Sometimes, it has got 15° angulation. The maximum width of the
blade is to pass a 20 G needle.
It is also available as a disposable blade in presterile pack which may be reused.
Uses
To make the side-port (to enter into the anterior chamber from the side of main
incision) in cataract surgery.
Indication of side-port
For paracentesis
To inject viscoelastic substance
To inject trypan blue dye
To clean subincisional lens cortex by irrigation aspiration cannula
To manipulate second instrument (like phaco-chopper, Sinsky hook, etc.) in
case of phacoemulsification. Some times, two side-ports are given on either
side of main port for bimanual irrigation and aspiration
To insert the anterior chamber maintainer.
It is also used for paracentesis to drain blood in hyphema.
To remove small intracameral foreign body.

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SCALPEL HANDLE (BARDPARKER HANDLE)

Identification: It is a flat handle with a short, grooved neck. Handle no. 3 is used in
ophthalmic surgeries. The blades are fitted with the neck is no. 11 or no. 15 (no. 11 is
triangular blade and no. 15 has curved elliptical tip).

Uses
Abexterno corneoscleral section for cataract surgery.
Trabeculectomy operation.
Skin incision as in DCR, ptosis or other lid surgeries.
To dissect the pterygium head from the cornea.
To give incision in chalazion operation.
For suture removal after cataract operation or keratoplasty.

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SPECULUMS
EYE SPECULUMS
The types are (1) universal eye speculum, (2) guarded eye speculum, (3) wire speculum.

Universal Eye Speculum

Identification: It has a spring and two limbs, and a screw to adjust the limbs.
It is called universal because it can be used on either side.
Method: It is fixed to the eyelids in such a way that screw should face outward and forward.
Uses: It is used to separate both eyelids for good exposure of the eyeball mainly during
extraocular operations,
e.g.
Pterygium excision,
Squint operation
Evisceration and enucleation
Debridement and cautery of corneal ulcer
To give subconjunctival or sub- injection
Removal of corneal foreign body
Removal of conjunctival cyst or mass
During suture removal.

It is not used routinely in intraocular operations as it gives pressure over the globe.
This causes rise in intraocular pressure (IOP) during operation. One can put a cotton
pellet or assistant can lift the instrument during intraocular operation to avoid rise in
IOP. Otherwise, stay sutures to the lids are commonly used for intraocular operation.

Disadvantages
Since it has no guard, eyelashes of upper lid (larger) come in the field of operation.
Not used in intraocular operation because of more vitreous-upthrust and risk of
vitreous loss by direct pressure on the globe.

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Guarded Eye Speculum

Identification: The upper limb of the speculum is having a guard plate which keeps the
eyelashes of the upper lid away from the field of operation. So, two instruments are required,
one for the right eye and the other for the left eye.

Uses: Same as universal eye speculum. It is especially useful in squint operation in

children and in pterygium operation.

Disadvantages
Operating field is reduced.
It is heavier, hence gives more pressure on the globe.

Wire Speculum
It is made up of a stainless-steel wire and there is no
screw. It is of universal type.
It is very light and hence gives little pressure on the
eyeball. So, it can be used safely during
intraocular operations as well as extraocular operation.

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Williams eye speculum Eye speculum with guard

Lieberman eye speculum Castroviejo eye speculum

Barraquer eye speculum Kratz-Barraquer eye speculum

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 FORCEPS
ARTERY FORCEPS (HEMOSTAT)

Identification:
This is a medium-sized, fully serrated forceps with catch. It may be straight or curved.

Uses
To hold lid stitches and superior rectus stitch, and then to fix the suture ends with head towel.
To crush lateral canthus in lateral canthotomy.
For hemostasis during dacryocystorhinostomy (DCR) or dacryocystectomy (DCT),
specially if the angular vein is damaged.
Fasanella-Servat operation in ptosis (to muscle and
levator muscle).
To hold muscle stump during enucleation.
To make irrigating cystitome from a 26 gauge needle.
To hold whole lacrimal sac prior to excision in DCT.

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SUPERIOR RECTUS HOLDING FORCEPS

Identification: It is a stout forceps with double curvature (S-shaped) at its ends.

It has 1: 2 teeth at its tip. Its curvature at the tip is to fit with the curvature of the globe

Uses: It is used to catch the superior rectus muscle belly for passing stay (bridle) sutures,
so that the eyeball can be rotated and fixed downwards in cataract, glaucoma or other
surgery. It is also used to catch the inferior rectus muscle as in keratoplasty.

SUTURE TIER FORCEPS

Identification: It is a small straight or curved forceps with long fine limbs. It does not have
any tooth at its tip. The tips are made stout by extra thick platform.
Uses
To hold the suture ends during tying the sutures after proper tightening.
To hold the cut ends of the suture during its removal.
May be used to catch the margin of incised conjunctiva during suturing.

Ophthalmology Instruments@eyeamnikhil 9
Identification: It is a fine medium-size toothless forceps with an angulation at about 7 8 mm
from its tip.
Uses
It is used to hold the intraocular lens during its placement in the posterior chamber.
It is used to catch and remove the loose anterior capsule after completion of capsulotomy.
It may be used as a suture tier during suturing with 10 0 nylon.

CAPSULORHEXIS FORCEPS (UTRATA FORCEPS)

Identification: It is a fine long forceps with curved sharp tip without any tooth.

Uses: To perform continuous curvilinear capsulorhexis (CCC) in case of manual SICS

or in phacoemulsification. The initiation of rhexis is started with a 26 G needle, and then
completed with the rhexis forceps, or it may be with the rhexis forceps alone.
It may be used to remove small capsular tag.
Ophthalmology Instruments@eyeamnikhil 10
INTRACAPSULAR FORCEPS

Identification:
It has also no tooth, and is single curved.
Its tips are more blunt (knob-like) and have cups on the their
inner surfaces.

Methods

forceps carefully, without catching the iris.

Side-to-side movement is made and simultaneous pressure over the zonules is given by the
lens expressor (taken in the left hand) from outside to tear them. Cataractous lens is taken out
by tumbling (i.e. lower pole is delivered first).
Uses
Intracapsular cataract extraction
To remove capsular tags in extracapsular cataract extraction (ECCE)
As a suture tier
To hold suture ends during suture removal,
To remove clots from the anterior chamber as in clotted hyphema
To remove caterpillar hair.
Complications of Intracapsular
Forceps Extraction
Iris may be caught leading to iridodialysis and hyphema.
Capsule may be torn leading to accidental ECCE.
Lens may get dislocated into the vitreous due to excessive pressure.
Corneal endothelial damage by the tip of the forceps.
Capsular grasp may open up in the midway of the procedure.

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PLAIN DISSECTING FORCEPS

Identification: It is an ordinary, straight forceps without any teeth at its tips. The ends
are little blunt, and on their inner surface, there are fine serrations for better grip.
Uses
To hold the bulbar conjunctiva during its dissection.
To hold episcleral tissue during its dissection.
It is also used during suturing of conjunctiva.
To hold conjunctiva during subconjunctival injection.
It may be used to hold small sponge swabs.

TOOTHED FORCEP

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EPILATION FORCEPS (CILIA FORCEPS)

Identification: It is a small stout forceps with blunt flat ends. Near the tip, the inner surfaces
are reinforced by extra thick platform which may be rhomboidal or elliptical
Uses
To remove the offending, misdirected eyelashes in trichiasis.
To remove the involved eyelash in stye.
No anethesia is required for epilation. It is not an ideal technique as it is not a permanent
procedure. As the root is not destroyed, eyelash grows again within 6 8 weeks and
causes same irritation.

Ideal method should be permanent where the hair-root is destroyed.

Ideal methods are: Electrolysis, Electrodiathermy, Cryosurgery

NEEDLE HOLDING

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PIERSE HOSKIN FORCEP

Identification
Tip notched

Uses
To hold delicate tissues

Advantage
Less traumatic

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FIXATION FORCEPS (EYEBALL FIXATION FORCEPS)

Identification: It is a medium-sized forcep with 2:3 teeth (may be 3:4) at its tip.

Method:
3 4 mm of limbus with left hand. Because, the conjunctiva is firmly adhere to episcleral
tissue and sclera around the limbus, and it is 4 5 layers thick. It may be used at other part

Uses
To fix the eyeball during operative procedures, like:
Cataract surgery
Paracentasis
Pterygium surgery
Needling, etc.
To catch superior rectus muscle to pass bridle suture.

To lift bulbar conjunctiva during subconjunctival or sub-Tenon injection.

Used in forced duction test (FDT) in case of squint to know any mechanical restriction
is present or not.
To hold the sponge piece, gauze piece or cotton ball for swabbing in depth.

BISHOP-HARMON IRIS TISSUE FORCEPS

Description:
Small, fine tissue forceps with long, thin jaws and three interlocking teeth at the tips.
Use(s):
Used for grasping tissue in and around the eye.

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CHALAZION CLAMP

Identification: It is a forceps with a large screw for fixing or tightening the limbs like a
clamp. One limb has got a solid disc-shaped plate and the other limb has a ring at its end.
It is hemostatic and self-retaining.

Method: The solid plate is applied on the skin surface of the lid and the ring side is applied
on the tarsal conjunctiva, encircling the chalazion. The screw is tightened and the lid
is everted and then chalazion is exposed for incision.

The functions of the screw are:

Fixation of the lid
Hemostasis by means of tightening.

Uses
To fix the chalazion for surgery and also to ensure hemostasis.
To give intralesional injection of steroids in chalazion after fixing it with forceps.
Excision of a small granuloma or papilloma of the lid.

CHALAZION SCOOP (CURETTE)

Identification: It is a small scoop with sharp edge, attached to a handle. The size of the
scoop may vary. Two different sized scoops may be attached to the two ends of same
handle for convenience.

Uses: To scoop out the granulation tissue after giving incision on chalazion. Scooping of the
chalazion must be complete, otherwise there may be chance of recurrence. After removal
of the chalazion forceps, the bleeding is controlled by pressure over the lid, against the
incised area. A pressure bandage is applied for few hours with antibiotic ointment.

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SCISSORS

Identification: It is much smaller scissors with spring action. It may be straight, curved
or angular.
Uses
To prepare conjunctival flap.
To cut 10 0 sutures in cataract or keratoplasty operation.
To cut trabecular flap in trabeculectomy.
To cut anterior capsular tags in ECCE.
To cut vitreous in open-sky vitrectomy, as in vitreous loss during ICCE or ECCE.
To cut corneal button after trephination in corneal grafting.
To cut iris in different types of iridectomy.

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CASTROVIEJO CORNEOSCLERAL SCISSORS

USES:
To enlarge corneal or corneoscleral
incision for
conventional ECCE and ICCE
To enlarge corneal incison in
keratoplasty.
Tu cut scleral and trabecular tissue in trabeculectomy

WESTCOTT SCISSORS
Description:
Spring-action scissors with fine, narrowed, blunt tips
that can be curved or straight.
Use(s):
Used for conjunctival dissection, incising the cornea,
sclera, and iris and for dividing eye muscles

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STEVEN TENOTOMY SCISSORS
Description:
Small fine scissors that can have curved or straight blades that narrow to blunt tips.
Use(s):
Used for dividing and dissecting the muscles and tendons of the eye. These are
commonly used for dividing the lateral and medial tendons and muscles of the eye
during recession and resection for strabismus.
Tenotomy Scissors
o Fine blunt tipped scissors
o Used to separate Tenon
o Used in buckling surgery, enucleation, eviseration, squint surgery

ENUCLEATION SCISSORS
Identification: It is a broad, stout scissors having uniformly
curved blades with blunt
tips. The scissors is curved to fit the curvature of the globe.
Use: It is used to cut the optic nerve with its sheaths during
enucleation operation.
Enucleation is the surgical removal of the
globe and a portion of the optic nerve from the orbit.

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CATARACT
THERMOCAUTERY (HEAT CAUTERY)

Identification: It is a metallic ball with pointed tip, attached to the end of a handle.
The ball is made up of steel or brass (brass retains heat for a longer time).

Method: The metallic ball is heated over the flame of a spirit lamp before cauterization.
When it is sufficiently hot, the pointed tip is applied to the bleeding points for hemostasis.

Uses
To cauterize any superficial bleeding points during operation on the eyeball (e.g. in
cataract operation and glaucoma operation after making the conjunctival flap).
To cauterize the bare scleral area in pterygium surgery.
To cauterize the margin of a progressive corneal ulcer.
To cauterize small iris prolapse.
Temporary punctal occlusion.
Advantages: It is cheap and easily available.
Disadvantages
As the application of heat is not uniform there may be more tissue charring at the
beginning of cautery.
More tissue charring may excite more tissue reaction.
The best method of hemostasis is by diathermy, or wet field cautery (hemostatic
eraser), where the hemostasis is uniform and tissue reaction is minimal.

CAPSULOTOME OR CYSTITOME

Identification: a bent tipped 26 gauze needle is used as a capsulotome or cystitome which is

fitted with a 2 mL syringe.
Uses:
Here, the capsulotomy is done by a close

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method after making limbal groove. The syringe is filled with balanced salt solution

needle manipulation. The capsule is cut with the bent tip of the needle in a continuous
circular fashion capsulorhexis, or by interrupted multiple puncture by can-opener
technique or stamp-hole technique. After withdrawing the needle, the limbal section is
extended and loose circular anterior capsule is removed.

Identification: It is an angular fine hook attached to a long round solid handle.

Methods and uses

It is used to dial the IOL for the purpose of centration and bringing the IOL-haptics in
horizontal position. The hook is positioned in the dialling holes of the optic of IOL, and
then to rotate in clockwise manner.
It may be used as a left hand instrument during phacoemulsification:
To rotate the lens nucleus.
To crack the lens nucleus after doing quadrant trenching.
To chop the nucleus.
It is used to break the posterior synechiae (synichiolysis) during ECCE.

Figure a sinsky hook

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Figure b No hole dialer

Figure c chopper

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VECTIS (WIRE VECTIS)

Identification: It is a ring of wire (round or oval) at the end of a narrow limb, attached to
a handle (like a large platinum loop). It may be little curved like a spoon.

Method: Pupil must be fully dilated. Never pass it blindly. The lens edge should be
visible. Carefully pass the vectis behind the lens. Lift the lens and then take the lens out.
Vitreous loss is inevitable in vectis delivery. Sometimes, a sector iridectomy is needed
instead of peripheral iridectomy. Open-sky vitrectomy is done after lens delivery.
Uses
To remove a subluxated or dislocated lens.
To deliver the nucleus in ECCE with irrigating vectis.

IRRIGATING VECTIS

Identification: It is a hollow vectis fitted with a needle base. Its tip has 3 5 small openings
for free passage of irrigating solution.
Use:
Or it may be fitted with a syringe filled with r BSS during nucleus delivery.
The irrigating fluid creates hydrostatic pressure and at the same time mechanical
pull by the vectis is to deliver the nucleus out. Posterior scleral lip depression and
simultaneous counter balancing force by superior rectus bridle suture are the important steps
during nucleus delivery.

Ophthalmology Instruments@eyeamnikhil 23
DASTOOR IRIS REPOSITOR

Identification: It is an shaped instrument with a stout handle and

two long narrow flattened extrimities. Both the edges and tips are blunt.

Method: A few strokes over the peripheral iris on its upper part is required to reposit the iris.
When the iris properly repositioned the pupil becomes perfectly circular and central.

Uses
To reposit the iris after the delivery of lens in ICCE or after nucleus delivery in ECCE.
To reposit the iris after iridectomy.
To retract the iris during cryoprobe application over the anterior surface of the
lens in ICCE.
To bring air from posterior chamber to anterior chamber during intracapsular
cataract surgery.
To break the adhesions in synechiae (synechiolysis).
To bring back the folded conjunctiva to cover the wound.
Lamellar dissection of the cornea in lamellar keratoplasty.

Ophthalmology Instruments@eyeamnikhil 24
IRRIGATION-ASPIRATION

TWO-WAY CANNULA (SIMCOE CANNULA)

Identification:
It is a two-way cannula, one end of which is attached to a blunt needle via a silicone tube.
Normally, this end is fitted with an irrigation or infusion system and the two-way cannula
itself is fitted with a 2 mL or 5 mL syringe for aspiration

Method: After delivery of the nucleus in ECCE, the cannula in introduced into the anterior

(or, alternately assistant may irrigate via BSS filled 10 mL syringe). As the anterior chamber
is formed, the surgeon starts aspirating cortical material slowly till the posterior
capsule is cleaned (as appreciated by brilliant fundal glow under co-axial illumination of
the operative microscope).

Uses
For simultaneous irrigation and aspiration of cortical materials in case of ECCE or
ECCE with PCIOL.
To remove viscoelastic material after insertion of IOL.
May be used to remove blood in hyphema.

Ophthalmology Instruments@eyeamnikhil 25
Identification: It is a straight long instrument with two flat spoons or spatula at the two
ends.
Uses
In intracapsular cataract extraction: Along with lens hook, the lens is delivered by pressure
and counter-pressure (Smith-Indian technique). Spoon is in the left hand outside
the section and lens expressor in the right hand at the lower limbus. By giving pressure
and counter-pressure, lens is delivered out by tumbling or by sliding.

LENS EXPRESSOR (LENS HOOK)

Identification: It has a flat corrugated handle with a curved, olive-pointed blunt tip. The
plane of the flatness of the handle is perpendicular to the plane of curvature of the limb.
Uses
During intracapsular-extraction of the lens, either by intracapsular forceps or by Smith-Indian
technique. Pressure is applied from out side at the limbus and adjacent part of the cornea at 6
on. This is to facilitate zonular tear. Then a gradual support is given at the lower
pole of the lens.
In case of extracapsular cataract operation to deliver the nucleus.
Milking out the cortical materials with the knee or bend of the instrument in ECCE.
It may be used to hook the extraocular muscles.
It may also be used as a fine tissue retractor, particularly in DCR operation to retract the sac
during punching or breaking the bone.

Ophthalmology Instruments@eyeamnikhil 26
Ophthalmology Instruments@eyeamnikhil 27
SQUINT
STRABISMUS HOOK (MUSCLE HOOK OR SQUINT HOOK)

Identification: It has a solid handle with a long narrow limb with 90° bent at its tip. The
tip may be sharp or knobbed. The handle is not corrugated and the plane of curvature of
the limb is same as the plane of handle.
Uses
It is used to hook the extraocular muscles during:
Squint operation
Retinal detachment operation
Enucleation operation.
Occasionally, it may be used as tissue retractor.

d Lens hook vs muscle hook

Ophthalmology Instruments@eyeamnikhil 28
OCCULOPLASTY

Identification: It is a long narrow solid cylindrical instrument with a smooth conical

pointed tip. Its body is corrugated for better gripping with thumb and index finger.

Uses
To dilate the punctum and part of the canaliculus before introducing lacrimal
cannula for syringing.
To dilate the punctum for probing in case of congenital dacryocystitis.
To dialate the punctum and then probing to identify lacrimal sac during DCR operation.
For dilatation of the punctum in congenital or acquired punctal stenosis.
Before dacryocystography (DCG).
May be used as a marker (by dipping the pointed tip in gention violet) in squint or
retinal detachment operation.

Identification: It is a thin, long probe with round lip. It is made up of stainless steel or
silver. They are of different diameters (size 00 to 08). Each instrument has two different size
probes attached centrally with a flat handle.
Uses: To probe nasolacrimal passage in:
Congenital punctal stenosis.
Congenital dacryocystitis if probing fails to achieve the patency of nasolacrimal
passage then one should go for DCR.
During DCR to identify the exact position of lacrimal sac for giving incision on the
sac wall.

Ophthalmology Instruments@eyeamnikhil 29
LACRIMAL DISSECTOR WITH

Identification: It is a narrow long instrument

with a stout pointed dissector at one end, and
the other end is having an elongated scoop.
Uses
Dissector end
It is used for blunt dissection of lacrimal sac after giving skin incision (both in
DCT and DCR operation).
It is used to clean the bone pieces from the punch, while punching or cutting
the bone of DCR.
Scoop end: To scoop out the tissue remnants by scraping from the upper end
of bony NLD after excision of the lacrimal sac (only in DCT).

Ophthalmology Instruments@eyeamnikhil 30
KERRISON BONE PUNCH

Identification: It is a large
instrument, which consists of a spring
handle and two long
blades. The upper blade has a hole
with sharp cutting edge and the lower
blade has a cup
like depression with sharp edge.
Use: It is used to punch or break the bones (lacrimal
bone, adjacent nasal bone and
frontal process of the maxilla) in DCR operation to
create a bony ostium. Ideally, two
different sized bone punches are required to make a
round bony opening of about 10 mm
diameter.

LID RETRACTOR

Identification: It is a saddle-shaped folded instrument at the end of a metallic handle. It

is of varying size depending upon the size of the palpebral aperture. It is not self-retaining.

Method (for children)

Patient is made to lie on the table and an assistant must fix his head.
Lignocaine (4%) eye drop is instilled.
Lid retractor is introduced in the eye from the temporal side sliding against the eyeball.
Upper lid is retracted and the eye is examined.
As the lower lid can be easily retracted by finger normally, lower lid retractor is not
necessary. But in some cases of severe blepharospasm, two retractors are needed.
Uses
It is used for examination of conjunctiva and anterior segment of the eye to find
Ophthalmology Instruments@eyeamnikhil 31
out any abrasion, ulcer, foreign body on the cornea or any abnormality:
In children and non co-operative patient.
In case of severe blepharospasm and photophobia.
In case of lid edema.
For removal of corneoscleral stiches (better than eye speculum) after cataract surgery.
To examine upper fornix by double eversion of the lid.
It may be used as a tissue retractor (e.g. to
squint and detachment operation).

Identification: This instrument is just like a small dinner fork. The ends of the fork are
bend downwards.
Uses
It is used to retract the skin, subcutaneous tissues and ligament during lacrimal sac
surgery.
It may also be used in other plastic operations of the eyelid.

EVISCERATION SPOON OR SCOOP

Identification: It has a large rectangular or oval shallow spoon attached to a handle. Its
shape is almost like a spade
Uses: It is used to scoop out the intraocular contents during evisceration. Evisceration is
the removal of the contents of the globe with inner two coats while leaving the sclera and
the optic nerve intact.
The structures scooped out are:
Lens
Vitreous
Whole uvea and
Whole retina.

Indications of evisceration:
Panophthalmitis,
In case of expulsive hemorrhage to assist auto-evisceration if the process is
incomplete rarely performed.

Ophthalmology Instruments@eyeamnikhil 32
 LID SPATULA (PLATE)

Identification: It is a flat solid instrument of

about 10 cm long. Its both ends are round and
convex. It is little curved or grooved at right
angle to its long axis, near its end.

Method: Before its application, eyeball is

smeared with antibiotic ointment to prevent
corneal abrasion. It is introduced under the lid
to provide a solid support during lid
surgery. Three stay sutures are usually passed
along the lid margins so that the assistant can
hold the sutures together along with lid plate
for better support during dissection.
Use: It is used in various lid surgeries, e.g.
ptosis, entropion, etc. It gives more exposure
of operative field than a clamp, but it does not
help in hemostasis.

ENTROPION CLAMP

Identification: It is a stout clamp with two limbs, and one screw for fixation. One limb
has got a solid semilunar plate and the other limb has U-shaped curved rim corresponding
to the semilunar plate. Right and left sided clamps are different.

Method: Same for both instruments. Eye is smeared adequately with antibiotic ointment
before its application to prevent corneal abrasion. Its solid plate is applied on the tarsal
conjunctival side and the fenestrated or rimside is on the skin surface (in reverse order of
chalazion forceps). The screw is tightened for fixation.

Use: Same for both. It is used to fix the lid during entropion operation. By tightening
the screw, it helps in hemostatis during operation. But it reduces the area of operative
field.

Ophthalmology Instruments@eyeamnikhil 33
GLAUCOMA
KELLYS PUNCH
( )

o Serrated squeeze action handle.

o Clean 0.75 mm round hole without tissue
tags
o This punch is used to create a trap door after
making a scleral flap. The punch
ensures that the trap door is full thickness

HAARMS
Harms Trabeculotomy Probe
o Two parallel arms (probe and guide) connected to
the shaft
o Available as right or left sided
o The internal arm is threaded into the Schlemm
canal using the external parallel
arm as a guide.

Ophthalmology Instruments@eyeamnikhil 34
CORNEA
CORNEAL MARKER

Use: guide the optimal placement of sutures in ketaratoplasty

Identification: It is a cylindrical instrument

which has three parts:
1. A circular blade

3. A cover to protect the sharpness of the blade. It is available in different diameters (like
6.0, 6.5,7.0, 7.5 ... 10, 10.5, etc. in mm). The obturator has a scale (marking 0, 2, 4, 6, etc.
in 1/10th of mm) which helps the surgeon to select exact depth of the cornea to be cut. This
is important in lamellar keratoplasty.

Uses:
keratoplasty. Now-a-days disposable corneal trephine is used.

Ophthalmology Instruments@eyeamnikhil 35
GENERAL

Identification: It is a measuring calliper in which the measurement (in mm) is adjusted

by spring action of a screw. The measuring ends are pointed like a compass, and the
scale is fixed to the opposite end.

Methods: The exact measurement is taken by adjusting the spring action of the screw which
is indicated by the pointed end on the scale.

Uses
To measure the size of the cornea, as in buphthalmos, congenital hereditary
endothelial dystrophy (CHED), megalocornea, microcornea, etc.
To use in various surgeries:
Phacoemulsification or small incision cataract surgery length of incision
Trabeculectomy length of scleral flap
Squint operation amount of resection or recession of the muscle
Keratoplasty to determine the size of the donor and recipient corneal button.
Retinal detachment surgery to measure the distance for passing encircling
band or to make port at pars plana
Intraocular foreign body (IOFB) removal to measure the site of incision for
IOFB removal
Ptosis surgery to measure the amount of lipopolysaccharide (LPS) to be
resected.
To measure the length for any purpose

Ophthalmology Instruments@eyeamnikhil 36
BARRAQUER NEEDLE HOLDER

Identification: It is a
medium-sized spring needle holder with two narrow and fine
curved jaws.
Uses: It is used to hold the fine needles (of 6-0, 8-0 and 10-0 sutures) for:
Corneoscleral suturing after cataract operation.
Scleral suturing in squint, detachment and trabeculectomy operations.
Corneal suturing in penetrating injury or keratoplasty.
Suturing the mucosal flaps in DCR operation.
Sometimes in conjunctival suturing.

SPONGE HOLDING

Ophthalmology Instruments@eyeamnikhil 37
TOWEL CLAMP

WELLS ENUCLEATION SPOON

Use: After severing all the recti muscles, it is passed from the lateral side deep inside the
orbit to get hold the optic nerve. Then, the scissors is used to cut the optic nerve.

Indications of enucleation
Absolute indications: When there is risk of life, or risk to the other eye due to the disease.
Malignant melanoma in adult
Retinoblastoma in children
Non repairable severely injured eye to prevent sympathetic ophthalmia in the
other eye.
Relative indications: Enucleation may be done in case of:
Painful blind eye due to absolute glaucoma, chronic iridocyclitis, intraocular
hemorrhage, etc.
Phthisis bulbi with calcification
Disfigured eye, e.g. anterior staphyloma, ciliary staphyloma, etc.
Sympathetic ophthalmia.
To collect donor eyes from the cadaver for eye bank for keratoplasty: By and
large, this is the most common indication of enucleation in ophthalmic practice.

Ophthalmology Instruments@eyeamnikhil 38