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Administering an eye anaesthetic: principles, techniques, and complications.

Fahmi A, Bowman R - Community Eye Health (2008)

View Article: PubMed Central - HTML - PubMed

Affiliation: Paediatric Ophthalmology Fellow, CCBRT Disability Hospital, Tanzania. Email: biophku@yahoo.com.

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The trigeminal nerve carries the sensory innervation of the eye and adnexa in three divisions: ophthalmic, maxillary, and mandibular... The sensory fibres of the eye and adnexa are found in the ophthalmic division – with the exception of a portion of the sensory input from the lower lid, which is carried by the maxillary division... However, it carries a higher risk of rare, yet serious, complications, such as globe perforation, retrobulbar haemorrhage, and injection of the anaesthetic into the cerebrospinal fluid (CSF)... Mastering the technique reduces these risks significantly... The sub-Tenon's block is more likely to be performed by an ophthalmic surgeon than by an ophthalmic anaesthetist... It enables top-up injections to be easily and safely given... Hyaluronidase can be used in a concentration of approximately 50 units/ml (range: 25 to 75 ml). slows the absorption of anaesthetic agents into the systemic circulation... This will provide a longer duration of action and reduce the risk of systemic toxic effects... Check that resuscitation equipment and medication is available to deal with a systemic complication, should one occur... Lie the patient flat in a safe and comfortable way, with head supported... Use a specially designed blunt cannula to inject the anaesthetic... However, if you do not have a specially designed cannula, a lacrimal cannula is a suitable alternative... Advance the cannula backwards with its tip touching and following the curvature of the globe all the way to the retrobulbar space... As the equator is passed, the hand and syringe need to rotate away from the globe so that the cannula tip stays in the space (Figure 6).

No MeSH data available.


Sub-Tenon's block: a pair of spring scissors is held perpendicularly to make a small (0.5 mm) snip incision through both the conjunctiva and Tenon's capsule, 2 to 3 mm behind the limbus in the inferomedial quadrant.
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Figure 7: Sub-Tenon's block: a pair of spring scissors is held perpendicularly to make a small (0.5 mm) snip incision through both the conjunctiva and Tenon's capsule, 2 to 3 mm behind the limbus in the inferomedial quadrant.

Mentions: Use a pair of spring scissors to make a small (0.5 mm long) snip through both the conjunctiva and Tenon's capsule, 2 to 3 mm behind the limbus in the inferomedial quadrant of the globe. The scissors should not be opened more than halfway. It is essential to find the sub-Tenon's plane, i.e. to dissect down to bare sclera. It helps to hold the scissor blades so that their plane is perpendicular to the ocular surface instead of being parallel to it (Figure 5).


Administering an eye anaesthetic: principles, techniques, and complications.

Fahmi A, Bowman R - Community Eye Health (2008)

Sub-Tenon's block: a pair of spring scissors is held perpendicularly to make a small (0.5 mm) snip incision through both the conjunctiva and Tenon's capsule, 2 to 3 mm behind the limbus in the inferomedial quadrant.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2377384&req=5

Figure 7: Sub-Tenon's block: a pair of spring scissors is held perpendicularly to make a small (0.5 mm) snip incision through both the conjunctiva and Tenon's capsule, 2 to 3 mm behind the limbus in the inferomedial quadrant.
Mentions: Use a pair of spring scissors to make a small (0.5 mm long) snip through both the conjunctiva and Tenon's capsule, 2 to 3 mm behind the limbus in the inferomedial quadrant of the globe. The scissors should not be opened more than halfway. It is essential to find the sub-Tenon's plane, i.e. to dissect down to bare sclera. It helps to hold the scissor blades so that their plane is perpendicular to the ocular surface instead of being parallel to it (Figure 5).

View Article: PubMed Central - HTML - PubMed

Affiliation: Paediatric Ophthalmology Fellow, CCBRT Disability Hospital, Tanzania. Email: biophku@yahoo.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The trigeminal nerve carries the sensory innervation of the eye and adnexa in three divisions: ophthalmic, maxillary, and mandibular... The sensory fibres of the eye and adnexa are found in the ophthalmic division – with the exception of a portion of the sensory input from the lower lid, which is carried by the maxillary division... However, it carries a higher risk of rare, yet serious, complications, such as globe perforation, retrobulbar haemorrhage, and injection of the anaesthetic into the cerebrospinal fluid (CSF)... Mastering the technique reduces these risks significantly... The sub-Tenon's block is more likely to be performed by an ophthalmic surgeon than by an ophthalmic anaesthetist... It enables top-up injections to be easily and safely given... Hyaluronidase can be used in a concentration of approximately 50 units/ml (range: 25 to 75 ml). slows the absorption of anaesthetic agents into the systemic circulation... This will provide a longer duration of action and reduce the risk of systemic toxic effects... Check that resuscitation equipment and medication is available to deal with a systemic complication, should one occur... Lie the patient flat in a safe and comfortable way, with head supported... Use a specially designed blunt cannula to inject the anaesthetic... However, if you do not have a specially designed cannula, a lacrimal cannula is a suitable alternative... Advance the cannula backwards with its tip touching and following the curvature of the globe all the way to the retrobulbar space... As the equator is passed, the hand and syringe need to rotate away from the globe so that the cannula tip stays in the space (Figure 6).

No MeSH data available.