Ophthalmology Instruments 2.0

OPHTHALMOLOGY
INSTRUMENTS 2.0
Dr. Nikhil D. Gotmare
M.B.B.S (GMC, Mumbai)
M.S. Ophthalmology (MAMC, New Delhi)
Senior resident in Ophthalmology,
Guru Nanak eye centre,
Maulana Azad medical college, New Delhi
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CONTENTS E. CATARACT
A. BLADES 1. Thermocautery (heat cautery)
1. Sclerocorneal splitter (crescent knife) 2. Capsulotome or cystitome
2. Angular keratome 3. Intraocular lens dialler (sinsky’s hook)
3. Mvr or v-lance blade 4. Vectis (wire vectis)
4. Side-port blade 5. Irrigating vectis
5. Scalpel handle (bardparker handle) 6. Dastoor iris repositor
B. EYE SPECULUMS 7. Irrigation-aspiration
1. Universal eye speculum two-way cannula (simcoe cannula)
2. Guarded eye speculum 8. Mcnamara’s spoon (lens spatula)
3. Wire speculum 9. Lens expressor (lens hook)
C. FORCEPS F. SQUINT
1. Artery forceps (hemostat) Strabismus hook (muscle hook or squint hook)
2. Superior rectus holding forceps G. OCCULOPLASTY
3. Suture tier forceps 1. Punctum dilator (nettleship’s)
4. Mcpherson’s forceps (kelman-mcpherson 2. Lacrimal probe (bowman’s)

forcep)
3. Lacrimal dissector with scoop (lang’s)
5. Capsulorhexis forceps (utrata forceps)
4. Kerrison bone punch
6. Intracapsular forceps (arruga’s capsule forcep)
5. Lid retractor (desmarre’s)
7. Plain dissecting forceps
6. Cat’s paw retractor
8. Toothed forcep
7. Evisceration spoon or scoop
9. Epilation forceps (cilia forceps)
8. Jaeger’s lid spatula (plate)
10. Needle holding
9. Entropion clamp
11. Pierse hoskin forcep
H. GLAUCOMA
12. Fixation forceps (eyeball fixation forceps)
1. Kellys punch
13. Bishop-harmon iris tissue forceps
2. Haarms
14. Chalazion clamp
I. CORNEA
15. Chalazion scoop (curette)
1. Corneal marker
D. SCISSORS
2. Corneal trephine (castroveijo’s)
1. Vannas’ scissors
J. GENERAL
2. Castroviejo corneoscleral scissors
1. Calliper (castroveijo’s)
3. Westcott scissors
2. Barraquer needle holder
4. Steven tenotomy scissors
3. Sponge holding
5. Enucleation scissors
4. Towel clamp
5. Wells enucleation spoon

A. BLADES
1. 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 of edge blade may be bevelled-up or
bevelled-down.
The blade has a forward angulation of 45° for better and parallel movement
during dissection.
sed to make sclero-corneal tunnel in manual SICS or phacoemulsification
(Fig.a)
Used for lamellar dissection of the cornea in lamellar keratoplasty.
For creating scleral flap or pocket in trabeculectomy.
Figure a- crescent blade being used for creating sclero-corneal tunnel in manual SICS

2. 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 2.2–2.8 mm diameter (for
phacoemulsification).
It is also available as a disposable blade in presterile pack.
Uses
Used to enter into the anterior chamber after making sclerocorneal tunnel in
manual SICS or phacoemulsification.
To make clear corneal incision in phacoemulsification (Fig.b)
4.5–5.5 mm diameter keratome (known as enlarger) is used to enlarge the
tunnel.
Figure b-To make clear corneal incision in phacoemulsification

3. MVR or V-Lance blade
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 (Fig.c)
Figure c-for making side port entry at the limbus.
4. 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.

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
• For staining of anterior capsule:
-To stain anterior capsule by injecting trypan blue dye
-To inject air (under which staining of capsule is done with dye)
-For washing off excess dye
• To inject viscoelastic substance
• To perform capsulorhexis with cystitome.
• To manipulate second instrument (like phaco-chopper, Sinskey hook,
etc.) in case of phacoemulsification.
• To clean subincisional lens cortex by irrigation aspiration cannula
• For bimanual irrigation and aspiration, two side-ports are given on
either side of main port
• To insert the anterior chamber maintainer.
• It is also used for paracentesis to drain blood in hyphema.
• To remove small intracameral foreign body.

5. SCALPEL HANDLE (BARDPARKER HANDLE) AND BLADES
Identification: It is a flat handle with a short, grooved neck. Handle no. 3 is

used in ophthalmic surgeries. The blades fitted in the neck are blade no. 11
(triangular tip) or blade no. 15 (curved elliptical tip).
Uses
Scleral incision of corneoscleral section for cataract surgery. (no.15)
Scleral incision in Trabeculectomy.
Skin incision as in DCR, ptosis or other lid surgeries (no.11)
Periosteal incision in DCR (no.11)
To dissect the pterygium head from the cornea.
To give incision in chalazion operation.

Figure e Scleral incision of corneoscleral
Figure d: Periosteal incision in DCR (no.11)
section for cataract surgery. (no.15)
Figure f: Skin incision as in DCR (no.11)

B. EYE SPECULUMS
The types are (1) universal eye speculum (2) guarded eye speculum (3) wire
speculum.
1. 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-Tenon’s
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.
2. 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.
3. 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.

Williams eye speculum Eye speculum with guard
Castroviejo eye speculum
Lieberman eye speculum

Barraquer eye Kratz-Barraquer eye speculum
speculum

C. FORCEPS
1. 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 clamp conjunctiva, tarsal plate, Muller’s
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.
2. 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.
g: Superior rectus bridle suture being passed, rectus muscle is held using SR forcep,
thread/suture is passed using a needle held with artery forcep
3. 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.

4. McPHERSON’S FORCEPS (KELMAN-McPHERSON FORCEP)
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.

5. 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.
Sometimes used to catch hold of iris while
doing surgical peripheral iridectomy.
It may be used to remove small capsular tag.

6. INTRACAPSULAR FORCEPS (ARRUGA’S CAPSULE FORCEP)
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.
Uses
In Intracapsular cataract extraction (ICCE) for lens delivery
[Lower pole delivery (Arruga’s method)
Here midperipheral lens capsule is grasped at 6 o’clock position by
intracapsular 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)]
Less common uses:

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
Methods of lens delivery in ICCE:

Capsule forcep method
Indian smith method
Cryoextraction
Irisophake method
Wire vectic method
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.

7. 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.
8. TOOTHED FORCEP

9. 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

10. NEEDLE HOLDING
11. PIERSE HOSKIN FORCEP
Identification
Tip notched

Uses
To hold delicate tissues like:
Conjunctiva during conjunctival repair, trabeculectomy
To hold pterygium tissue during excision
To hold Limbus for globe stabilisation during various steps of surgery e.g while
making incisions, paracentesis, capsulorhexis etc
To hold cornea followed by sclera while passing sutures in ECCE (corneal bite
followed by scleral bite)
To hold cornea when inserting non foldable IOL with KM forcep
To hold cornea while suturing in keratoplasty
Advantage
Less traumatic

12. FIXATION FORCEPS (EYEBALL FIXATION FORCEPS)
Identification: It is a medium-sized forcep with 2:3

teeth (may be 3:4) at its tip.
Method: The conjunctiva and episcleral tissue are

firmly held at 6 o’clock position within
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 around the limbus (e.g. 3 o’clock, 9 o’clock, etc.).
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 catch other tissues, e.g. skin, Tenon’s capsule, etc.
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.
13. 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.

14. 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.

15. 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.

D. SCISSORS
1. VANNAS’ 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.

2. 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
To perform conjunctival peritomy in ICCE, ECCE etc

3. 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
4. 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‘s from underlying sclera
o Used in buckling surgery, enucleation, eviseration, squint surgery

5. 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.
E. CATARACT
1. 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.

2. 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:
To perform continuous curvilinear capsulorhexis (CCC)
in Phacoemulcification, SICS
To perform capsulotomy (Can-opner) in conventional
ECCE
3. INTRAOCULAR LENS DIALLER (SINSKY’S HOOK)
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.
To prolapse nucleus into anterior chamber for delivery during
SICS
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 h sinsky hook
Figure i No hole dialer
Figure j chopper

4. 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 in ICCE.
5. 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: To deliver the nucleus in ECCE and SICS.
The vectis is connected with the tubing system of a Ringer’s lactate or BSS
bottle or it may be fitted with a syringe filled with Ringer’s lactate or 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.
6. DASTOOR IRIS REPOSITOR
Identification: It is an elongated ‘S’ or ‘Z’– 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.
7. 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
chamber. The infusion is slowly started either from a hanging Ringer’s lactate
or BSS bottle
(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 SICS
To remove viscoelastic material after insertion of IOL.
May be used to remove blood in hyphema.
8. McNAMARA’S SPOON (LENS SPATULA)
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.

9. 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 o’clock position. 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.

F. 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.
k Lens hook vs muscle hook

G. OCCULOPLASTY
1. PUNCTUM DILATOR (NETTLESHIP’S)
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.

2. LACRIMAL PROBE (BOWMAN’S)
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.

3. LACRIMAL DISSECTOR WITH SCOOP (LANG’S)
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).

4. 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.

5. LID RETRACTOR (DESMARRE’S)
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 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 retract conjunctiva and Tenon’s
capsule in
squint and detachment operation).

6. CAT’S PAW RETRACTOR
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.
7. 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.

8. JAEGER’S 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.
9. 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: 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.

H. GLAUCOMA
1. KELLYS PUNCH
(Kelly Descemet‘s Membrane 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
2. 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.

I. CORNEA
1. CORNEAL MARKER
Use: guide the optimal placement of sutures in ketaratoplasty

2. CORNEAL TREPHINE (CASTROVEIJO’S)
Identification: It is a cylindrical instrument which has three parts:

1. A circular blade
2. An adjustable inner core or ‘obturator’
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: To cut the ‘donor’ and ‘recipient’

corneal button in penetrating and lamellar
keratoplasty. Now-a-days disposable
corneal trephine is used.

J. GENERAL
1. CALLIPER (CASTROVEIJO’S)
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

2. 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.

3. SPONGE HOLDER
Used: To hold spirit swab

and betadine swab to clean
and paint periocular area
before surgery
4. TOWEL CLAMP

5. WELLS ENUCLEATION SPOON
Use: During enucleation, 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 passed below the spoon to cut the optic nerve.
Indications of enucleation
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.
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.

Note- All the steps of cataract surgeries and instruments used in
Phacoemulsification, manual SICS, conventional ECCE and ICCE are covered
in this video
Cataract surgeries:
https://youtu.be/wXWLxd5pq7U
Videos on phacoemulsification and SICS Separately:
Phacoemulsification:
https://youtu.be/JOrdbs6icKs
SICS:
https://youtu.be/XcRsuBnJ3Tw

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Ophthalmology Instruments 2.0

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OPHTHALMOLOGY

Eyeamnikhil by Nikhil Gotmare

SEE with NIKHIL

Ophthalmology Instruments 2.0 @eyeamnikhil 1

A. BLADES 1. Thermocautery (heat cautery)

1. Sclerocorneal splitter (crescent knife) 2. Capsulotome or cystitome

2. Angular keratome 3. Intraocular lens dialler (sinsky’s hook)

3. Mvr or v-lance blade 4. Vectis (wire vectis)

4. Side-port blade 5. Irrigating vectis

5. Scalpel handle (bardparker handle) 6. Dastoor iris repositor

B. EYE SPECULUMS 7. Irrigation-aspiration

1. Universal eye speculum two-way cannula (simcoe cannula)

2. Guarded eye speculum 8. Mcnamara’s spoon (lens spatula)

3. Wire speculum 9. Lens expressor (lens hook)

1. Artery forceps (hemostat) Strabismus hook (muscle hook or squint hook)

2. Superior rectus holding forceps G. OCCULOPLASTY

3. Suture tier forceps 1. Punctum dilator (nettleship’s)

4. Mcpherson’s forceps (kelman-mcpherson 2. Lacrimal probe (bowman’s)

Ophthalmology Instruments 2.0 @eyeamnikhil 2

Ophthalmology Instruments 2.0 @eyeamnikhil 3

Figure b-To make clear corneal incision in phacoemulsification

Ophthalmology Instruments 2.0 @eyeamnikhil 4

Identification: It is a fine straight instrument with triangular

Figure c-for making side port entry at the limbus.

Ophthalmology Instruments 2.0 @eyeamnikhil 5

Ophthalmology Instruments 2.0 @eyeamnikhil 6

Identification: It is a flat handle with a short, grooved neck. Handle no. 3 is

Ophthalmology Instruments 2.0 @eyeamnikhil 7

Figure f: Skin incision as in DCR (no.11)

Ophthalmology Instruments 2.0 @eyeamnikhil 8

1. UNIVERSAL EYE SPECULUM

It is not used routinely in intraocular operations as it gives pressure over the

Ophthalmology Instruments 2.0 @eyeamnikhil 9

2. GUARDED EYE SPECULUM

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

Ophthalmology Instruments 2.0 @eyeamnikhil 10

Castroviejo eye speculum

Lieberman eye speculum

Ophthalmology Instruments 2.0 @eyeamnikhil 11

2. SUPERIOR RECTUS HOLDING FORCEPS

Ophthalmology Instruments 2.0 @eyeamnikhil 12

3. SUTURE TIER FORCEPS

Identification: It is a small straight or curved forceps with long fine limbs. It

Ophthalmology Instruments 2.0 @eyeamnikhil 13

Identification: It is a fine medium-size toothless forceps with an angulation at

Ophthalmology Instruments 2.0 @eyeamnikhil 14

Uses: To perform continuous curvilinear

Ophthalmology Instruments 2.0 @eyeamnikhil 15

Less common uses:

Methods of lens delivery in ICCE:

Ophthalmology Instruments 2.0 @eyeamnikhil 16

Identification: It is an ordinary, straight forceps without any teeth at its tips.

Ophthalmology Instruments 2.0 @eyeamnikhil 17

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

Ophthalmology Instruments 2.0 @eyeamnikhil 18

11. PIERSE HOSKIN FORCEP

Ophthalmology Instruments 2.0 @eyeamnikhil 19

Conjunctiva during conjunctival repair, trabeculectomy

To hold pterygium tissue during excision

To hold cornea when inserting non foldable IOL with KM forcep

To hold cornea while suturing in keratoplasty

Ophthalmology Instruments 2.0 @eyeamnikhil 20

Identification: It is a medium-sized forcep with 2:3

Method: The conjunctiva and episcleral tissue are