are used for many operations. The specialist prepares this suture as described for
swaged-on sutures, taking care not to exert pull on either of the needles. He must also
avoid pricking his gloves with the needles. Both of the swaged-on needles are clamped
into needle holders before the suture is handled. Either interrupted or continuous
stitches may be taken, depending upon the preference of the surgeon.
OPERATIONS ON THE EYES
a. Introduction. In the following text, some examples of surgical procedures on
the eyes are defined in order to acquaint the specialist with these operations. When the
specialist is assigned to scrub or circulate for an eye operation, he is to perform duties
as indicated in paragraphs 1-3 through 1-7, using whatever modifications may be
b. Extraocular (Outside the Eye) Procedures. The operations discussed in
paragraphs 1-9 through 1-11 are those done outside the eye. Anesthesia used maybe
either general or local depending upon the needs of the situation.
c. Intraocular (Within the Eye) Procedures. Operations performed within the
eye are discussed in paragraphs 1-12 through 1-17. Anesthesia of choice is
usually--though not always--local.
PROCEDURES ON EYELIDS
a. Plastic Repair of Eyelid. Various reconstructive techniques may be
employed by the surgeon in repairing the eyelid following lacerations or burns. Plastic
repair may also be indicated as treatment for acquired malfunctions of the eyelid. Such
malfunctions sometimes result from scars that form after the healing of injuries or burns
of the lids. These malformations may be classified as follows:
(1) Ectropion. This is the rolling outward of the eyelid margin so that a
portion of the conjunctiva is exposed. It is usually accompanied by epiphora (tears
running down the cheek). This condition may be caused by injury or it may occur
spontaneously in elderly persons with no history of injury.
(2) Entropion. This is the rolling inward of the lid margin so that it presses
against the cornea and the eyelashes are in contact with the eyeball.
b. Tarsorrhaphy. This is the surgical closure of the lids by a plastic operation.
It is indicated when the lids cannot close sufficiently to cover the cornea during sleep
(exposure of the cornea results in the drying of its surface and produces corneal ulcer).
c. Excision of Chalazion. A chalazion is a small benign tumor of the eyelid.
The removal of a chalazion is indicated when the chalazion fails to disappear without
surgical intervention in the course of several weeks. (Approximately 70 percent of
chalazia require excision.) In addition, excision is indicated if the chalazion