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.

LIM’S FORCEPS
 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.
ARRUGA’S INTRACAPSULAR FORCEPS

• 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.
CAT’S PAW LACRIMAL WOUND RETRACTOR

• 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.
 BARRAQUER’S NEEDLE HOLDER

• 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.
 ARRUGA’S NEEDLE HOLDER

• 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

Barraquer’s needle holder