type of surgery. Retrobulbar injection is usually performed 10 to 15 minutes before
surgery to produce a temporary paralysis of the extraocular muscles.
(c) Block or regional anesthesia. The solution is injected into the base
of the eyelids at the level of the orbital margins or behind the eyeball to block the ciliary
ganglion and nerves. For eyelid repairs, the solution is introduced through the lower lid.
For operations on the lacrimal apparatus, the anesthetic is injected at the level of the
anterior ethmoidal foramen in order to anesthetize the internal and external nasal
nerves. In the Van Lint block method, procaine solution is injected into the orbicular
muscle and reaches the ends of the facial nerve.
(5) General anesthesia. A general anesthetic, with or without intravenous
injection of thiopental sodium (Pentothal Sodium ) is used when a patient is unable to
cooperate because of youth, dementia, or nervousness, or because the solutions of 20
percent mannitol (Osmitrol ) or 5 percent glucose in water are given intravenously
during surgery. A sedative is given the night before surgery, and a drying agent
(atropine or scopolamine) and an analgesic are given 1 to 1 1/2 hours prior to surgery.
The patient must not eat or drink anything for 6 hours prior to induction.
CONSIDERATIONS AT THE COMPLETION OF SURGERY
a. At the completion of the operation, the surgical area is cleansed, using saline
b. Antibiotic ointment may be thinly spread over the skin and eyelashes to
prevent adhesion of the bandage. This is frequently done after plastic procedures on
the lids or lacrimal duct.
c. Dressings are applied to prevent palpebral movements, protect the operative
wound from dust and external contaminants, and absorb any blood and tears that are
d. The initial dressing usually consists of a piece of fine cotton. An eye pad that
is commercially prepared and sterilized is applied over the cotton splint. The eye
dressing may be held in place by means of paper tape.
e. After intraocular operations, when external pressure on the eyes might be
very harmful, the initial dressing is covered with a protector such as a wire gauze cap,
perforated aluminum plate, convex perforated metal cup, convex flexible celluloid plate,
or some other kind of shield.
f. A pressure bandage may be used in some cases when a compression effect
is desired. The gauze roller bandage is applied over the initial dressing, encircling the
g. The instruments are carefully cleaned and sterilized.