Oculoplastic Eyelid Surgery Evansville
Surgeons that specialize in Eyelid Surgery.
Dr. David Malitz 4/5 Stars
Dr. Kathleen A. Flannagan (Schwierling) 2/5 Stars
Call for an appointment 812-421-2020 or fill in the form below.
Offering Cosmetic and Reconstructive Eyelid Surgery.
- Blepharoplasty Upper and no stitch Lower
- Entropian
- Ectropian
- Lid Lesions – Basal Cell Cancer, Skin Tags, Cysts, Chalazions, Hordeolums
- Ptosis (now offering Upneeq)
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Thanks to nurse sandy from the USA for this presentation shared via the CC license.
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Nurse Sandy will tell you about some
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common oculoplastic surgeries we perform
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in our minor procedure room the
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objectives are listed and at the end of
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this talk you’ll be able to identify the
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anatomic deficit causing the eyelid
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malposition
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you’ll be able to describe the surgical
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techniques to repair it and also discuss
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the nursing care before and after
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surgery for centuries
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atomic patients have been troubled with
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more than just cataracts and glaucoma
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ptosis lower lid laxity and even a
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lacrimal fistula have been a nuisance
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for patients for as these drawings show
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and even in the st century we are
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still dealing with lumps and bumps
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eyelid mal positions the delivery of
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surgical care has shifted from the acute
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hospital setting to outpatient
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facilities and or minor procedure rooms
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within the doctors offices minor
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surgical procedures that use only a
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local anesthetic have proven to be safe
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and cost effective here’s a list of the
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different medical practices using minor
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surgical procedures and I just wish to
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comment on the intra visual injections
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and the research I’ve done for this
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lecture that in there were an
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estimated million in trivial in
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Jackson’s performed in the USA so using
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sterile instruments and aseptic
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technique the surgeons hands are
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scrubbed wearing sterile gloves sterile
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drape the patient’s skin is prepped
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we’re able to perform minor surgeries
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and here are two types of minor
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surgeries being performed the slide on
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the right
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chose surgeons with full drape and
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sterile gowns and that’s a choice we use
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when we do blepharoplasty or ptosis but
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most other procedures are as the surgeon
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in the first slide shows and it’s much
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like going to the dentist we accept that
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we walk in we wear street clothes into
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the procedure room we have a local
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injection there’s a slight discomfort
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but then the procedure is done
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there’s no IV or anesthesia gases or
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sedation now these two slides are giving
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you an idea of what our minor procedure
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room looks like we have glass cabinets
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so we can see where our supplies are
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located we have a electric surgical
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chair that reclines the patient and then
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we often sit them up particularly doing
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during a ptosis surgery to evaluate the
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height of the eyelid and also the
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symmetry of it with the an operated eye
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and then we recline the patient we have
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the overhead surgical lamps and we have
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a coterie machine we have Mayo stands a
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back table when we do a full drape and
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you’ll notice a red emergency cart that
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has an oxygen tank suction and also an
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automated external defibrillator as well
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as emergency medicines IV supplies and
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Ambu bag because we are healthcare
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providers and the unexpected can happen
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during our minor room procedures we’ll
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monitor the patient’s we have a pulse
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oximeter and we have an automated blood
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pressure monitoring machine and now
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let’s have a look at some of the ocular
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anatomy that we’re going to be reviewing
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today we’re focusing on what’s called
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the ocular nexor those accessory
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structures to the eye it’s not the eye
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itself and in particular we’re going to
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focus on the eyelids and the lacrimal
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system the eyelids are moveable folds of
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skin which cover the eye and they
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function to protect from trauma to
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reduce excess light from entering the
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and to spread the tear film across the
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cornea we blink our eyes on the average
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of four to six times a minute the
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palpebral fissure is a vertical and
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horizontal measurement of the eyelids
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and the horizontal length is measured
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from corner to corner which is the
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medial canthus is the aspect of our
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eyelids next to the nose and the lateral
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canthus is directly opposite but more
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importantly is the fissure height which
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in the adult is normally to
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millimeters it’s measured through the
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pupil from the upper to lower eyelid as
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you’re looking at this normal eye the
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white sclera as it is covered with the
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conjunctiva which is a mucous membrane
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that also lines the eyelids
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there are goblet cells which secrete a
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mucus to help with tear lubrication in
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the medial cancel area you see two
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fleshie mounds of tissue the plica
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semilunaris is a folded portion of
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conjunctiva and the caracal is a
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modified form of canceled tissue and it
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has some sweat and oil glands what I’d
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like to also point out in this photo is
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that the upper eyelid is covering
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perhaps one to two millimeters of the
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cornea and the lower eyelid is just
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touching the limbus and this tells me
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that this eyelid is in good position to
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have an effective blank and when people
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are troubled with eyelid lesions or such
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they’re not going to be able to moisten
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their eye the first layer of is as I
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mentioned with skin we’re now looking at
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the orbicularis oculi muscle which is
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the muscle we use to squeeze our eye
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shut and to wink and beneath the
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orbicularis muscle is the septum which
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is a fibrous tissue extending from the
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orbital rim and forming our eyelids with
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thickened place of tissue that we called
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Tarsus upon the tarsal plates are these
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groupings of glands
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the gland of zeiss r the ciliary
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follicle or eyelash and secretes a
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sebaceous oil the gland of Moll is a
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modified sweat gland and the my bohmian
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glands are sebaceous oily glands that
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secrete a substance called my bum that
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reduces the tear film from evaporating
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as quickly as it might and the black
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arrows here are pointing to the openings
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of the meibomian gland on the tarsal
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edge there are orbital fat pads that
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serve to protect the eye and to be a
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reserve of energy and the gentleman has
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a
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pooching in his upper orbit that
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indicates a prolapse of his orbital fat
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because the septum has weakened with age
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as all things will and the septum no
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longer contains the orbital fat in its
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pouch there are tendons and muscles of
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the eyelids the medial canthal tendon
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and lateral canthal tendon help support
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the eyelids and the medial canthal
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tendon is attached to the bone of the
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maxilla our facial bone and the lateral
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canthal tendon is attached to which
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anoles tubercle a bony prominence on the
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zygomatic bone of the orbit there are
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muscles to help open and close our eyes
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that we often call retractors and the
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levator muscle of the upper eyelid is
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attached to the upper eyelid tarsal
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plate and a fibrous tissue formation
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from the inferior rectus is the capsule
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Oh help here of fashio now a closer look
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at all this muscle structure the levator
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has a more formal name levator palpebrae
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superioris and as it comes out from the
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orbit onto the tarsal plate it changes
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from a skeletal muscle to a pearly white
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fibrous tissue that is called
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aponeurosis and that’s what is attaching
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the levator muscle to
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the eyelid next to the aponeurosis is a
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smooth muscle that contributes about one
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to two millimeters of eyelid elevation
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and that is called Mueller’s muscle the
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over the lower eyelid retractor as I
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said is a fibrous piece of tissue from
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the inferior rectus and it’s true job is
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just to help hold the lower eyelid erect
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the lacrimal system has a lacrimal gland
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in the superior temporal orbit area and
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has ducts that open on to the eye
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we blank and the tear moves over to the
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lacrimal drainage system in the medial
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aspect of your upper and lower eyelids
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there are two drains punctum and they
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have their piping’s into the common
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canaliculi and into the lacrimal sac and
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eventually into our nose so here’s a
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question that will give you a few
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seconds to respond to and that is
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included in the ocular adnexa are all
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but one of the following lacrimal
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apparatus glands of mall zeiss and my
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bohmian retina or tarsal plate of
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eyelids so please let us know which
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answer is the one you like and incorrect
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all righty a hundred percent we have a
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really smart crew on board thank you for
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responding so let’s get started with
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having our first patient we’re always
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going to do a complete eye exam on our
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patient to be sure there’s no other
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ocular problems we want to know their
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medical history medicines are taking and
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if they are allergic to anything and
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proceed to evaluate and determine what
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their eye problem is from an
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oculoplastic standpoint and so this
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young lady has come to us with a
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chalazion in some parts of the world
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I’ve heard colossi on you here Tomatoes
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tomahto it’s all correct and it’s a
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constipated my bohmian gland and she’s
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had it about two weeks it’s painless but
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it’s annoying she did use the warm
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compresses but it didn’t resolve her
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problem and so we’re going to schedule
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her for an incision and drainage of the
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chalazion
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our minor surgery instructions are in
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this format to check with the patient
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and confirm that they are not taking any
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blood thinners otherwise we will need
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for them to stop that we want them to
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not use aspirin ibuprofen alka-seltzer
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Eckstrom buffering for two weeks before
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surgery and that also includes the
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supplement vitamin E or alcohol for two
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weeks vitamin E and alcohol also make
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your platelets less sticky we do want
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them to take their routine meds on the
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day of surgery and to have a light meal
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and drink we don’t want them wearing
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makeup and/or fingernail polish and to
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wear comfortable clothing and they must
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have someone to drive them home well
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this young lady doesn’t take any
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medicines except birth control she has
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no allergies and she has agreed to only
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use Tylenol if she has an ache or a pain
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the day of surgeries arrived and this is
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nurse Keenan he’s from Kenya he’s
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working on the Flying Eye Hospital as I
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speak and he has the thumbs up because
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she
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has eaten the light meal she did take
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her birth control she has someone to
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drive her home blood thinners are not a
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part of her lifestyle she did go to the
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restroom beforehand her consent is
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signed and the operative eye is marked
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her vital signs are stable and we are
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completing the surgical safety checklist
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as you can see these patients are
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wearing their street clothes there in
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the minor procedure room they just have
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a surgical hat on to keep their hair out
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of the way we have our masks on we’ve
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opened up the instruments and these are
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just some of the instruments that we’ll
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use for an incision and drainage of a
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chalazion Wescott’s . forceps a
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chalazion curette often called we call
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it a spoon a chalazion clamp a bard
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parker blade handle a number gauge
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needle and a bottle of xylocaine % the
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color is blue and it indicates there’s
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no additives in that so I know that it’s
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just plain lidocaine xylocaine I wanted
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you to see a bottle of lidocaine % with
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epinephrine one to a hundred thousand
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died Lucian my surgeons prefer to use
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this mixture because of the
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vasoconstrictive properties of
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epinephrine we’re cutting tissue and it
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helps to minimize the bleeding you will
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find what your surgeons prefer to use
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and that’s what you’ll use we’ll also
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have a number blade and cautery
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q-tips and some four-by-fours
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so we’re injecting the local anaesthetic
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into the patient’s eyelid and while this
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happens we have them hold our hand so
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that we can count down to when they
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don’t feel any discomfort the surgeon is
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also gently talking to them and I go
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into kind of a trance talk in terms of
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ten nine eight you’re doing great that’s
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great just think the medicine is getting
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absorbed into your tissue
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you’re doing wonderfully : and usually
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by the time we reach one the medication
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has taken effect I begin I can feel my
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hand again because their grip has
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relaxed and we proceed with surgery
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sometimes I have to count a little
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longer because patients might need a
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little more medication but it’s very
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effective to hold their hands and so we
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apply the chelation clamp and we flip
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the eyelid so that we can work from the
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conjunctival side and that is the
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chicken fat or the my bum that is kind
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of congealed and the gland could not
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excrete it and we remove it with our
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chalazion spoon and then we’ll maybe do
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a little coterie we’ll apply a steroid
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antibiotic ointment will pressure patch
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the eye and ask them to remove that in
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six hours or before going to bed we’ll
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ask them to use the ointment three times
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a day for a week and then we’ll see them
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back in two weeks and we always call our
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patients to see how they’re doing day
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one post-op how are you feeling is the
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pain manageable swelling any issues with
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bleeding or any other questions they
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might have for many people they’re
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saying you know I I didn’t want to call
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but you’ve just lifted a burden off
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their shoulder and sometimes we have to
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call them a second day or a few days
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later and if we need for them to talk
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with the doctor we will here’s another
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question the levator aponeurosis
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attaches to the upper eyelid at which
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nulls tubercle lockwood’s like ligament
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or the tarsal plate got about seconds
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to give a reply please
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[Music]
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all righty
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goldstar for everybody tarsal plate is
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the correct answer let’s have a look at
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this problem called ptosis which is
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drooping of the upper eyelid and in this
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older gentleman we can see that that
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left eye that palpebral fissure is much
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smaller than the normal to
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millimeters and the black arrows in the
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picture on your right are showing the
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white aponeurosis and it’s detached it’s
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not where it needs to be to hold the
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eyelid in proper place so aquired up who
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neurotic ptosis is the most common form
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of ptosis whether it’s stretching or
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dehiscence of the aponeurosis frequently
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patients who have they rubbed their eyes
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a lot or if they are contact lens
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wearers the hard contact lens where they
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have to pull on the upper eyelid to help
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push the contact lens out of their eye
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that can contribute to the aponeurosis
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weakening its hold and also a lot of
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times patients will notice after they’ve
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had intraocular surgery particularly
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cataracts now they can see better and
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they go wow that eyelid is really droopy
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I want to have it fixed so they come in
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for their complete eye examination and
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we’ll be reviewing a young lady a rather
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an older lady who’s had who has ptosis
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and she does take a baby aspirin
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milligrams well we do need for her to
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check with her doctor about stopping
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that we need the prescribing doctor to
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recommend that she can stop the aspirin
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because we don’t want to compromise her
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health and we instruct her about aspirin
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and ibuprofen echo trim the vitamin E
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she doesn’t drink alcohol and all the
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rest of the items listed here we will
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tentatively book her appointment but we
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need for her to confirm that she can
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stop the baby aspirin well Keenan’s got
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his thumbs up and she did call us back
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to confirm she could be off the baby
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sprin for a week and so schedule of
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surgery is going to happen she has a
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driver and we’ve confirmed there have
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been no other medicines that could thin
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her blood the consent is signed
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it’s a unilateral procedure so we are
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marking the eye her vital signs are
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stable and we are completing our
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surgical safety checklist the local
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anesthetic is injected along the marked
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skin crease and the instruments you’re
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looking at include Oh a number blade
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on that bard Parker blade handle a rake
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a bipolar cautery tip needle holder
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damar retractor and a few more forceps
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and q-tips the skin is incised and your
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second picture is showing you the septum
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being open to the levator aponeurosis
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the skin and Obi culeros are retracted
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in the forceps and the first needle is
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pointing to the yellow fat pad and
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beneath it the lower needle is pointing
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to the pearly white aponeurosis the
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slide on your right is showing you how
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that levator aponeurosis needs to be
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drugged back down onto the tarsal plate
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we have placed some o vicryl sutures
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and there are temporary ties because at
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this point we want to sit the patient up
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to view how the eyelid height is the
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contour before we place the suture and a
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permanent tie we’re satisfied so we
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recline the patient we finish our
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suturing we close the orbicularis with
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absorbable suture and then close the
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skin with a o nylon and after surgery
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we have our patients recline in a chair
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with cold compresses minutes on
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minutes off for the next to hours
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this is to minimize the swelling and
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also it’s comforting it feels good we
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teach them how to use x
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cause get them wet wring them out and
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then place them in the freezer where
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they can get really icy cold and they
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make a very good and light cold compress
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you can also do it with a cloth
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washcloth some people really like using
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frozen peas so whatever works for them
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will ask them to use antibiotic ointment
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to the incision suture sites three times
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a day for a week and come back for
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suture removal we’ll go ahead and give
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them some tylenol because it is normal
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to have some discomfort and a
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prescription for percocet should they
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need something stronger we ask them to
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not continue to not use ibuprofen but
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this young lady is going to resume her
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aspirin milligrams per the
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instructions from her doctor and
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whenever patients do have to stop a
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medication we checked with our surgeon
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when they report back that they can be
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off it for X amount of days to confirm
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that that is satisfactory for us to deal
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with in the minor procedure room and
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should the patient continue to have
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discomfort in spite of using percocet
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then we’ll need for them want them to
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call the office so we can determine
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what’s going on we continue with that
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post-op day number one phone call to see
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how are you doing is the pain manageable
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how’s the swelling sometimes there’s
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lower lids swelling and that’s just due
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to the lymphatic drainage system and so
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there may be some puffiness there which
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is normal but if there are any questions
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that we can’t answer we’ll have the
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doctor speak with them directly
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the next problem we’re going to look at
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is called ectropion and that is laxity
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in the horizontal dimension of the
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eyelids it can be the medial kanthal
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and/or the lateral canthal tendon now as
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you look at this gentleman’s lower
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eyelid there is no way all that sclera
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showing that his eyeballs can be
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comfortable that lower eyelid
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bilaterally is not touching the limbal
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space and so when you just look
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someone you can begin to tell what their
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problem might be and in the case of this
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gentleman anatomically the picture I’m
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showing of laxity of a lateral canthal
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tendon his procedure is to tighten the
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lateral canthal tendon we’ve completed
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our examination this is a patient who
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takes a blood pressure medicine and
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something for his cholesterol so that’s
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fine just continue to take those
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medicines please no aspirin ibuprofen or
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echo trend etc
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oh this gentleman likes a cocktail every
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evening so we’ve asked him to stop that
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and we are going to schedule him two
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weeks out from having stopped his
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alcohol intake he can have someone drive
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him he’ll wear comfortable clothing etc
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the day of surgery the patient has not
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had a drink for the two weeks he’s taken
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his usual meds his vital signs are
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stable he’s been to the restroom the
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procedure is bilateral so we don’t need
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to mark the eye and he has signed a
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consent and we’re completing the
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surgical safety checklist so after
:
injection of local anaesthetic we
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perform a lateral canthotomy so that we
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can view the orbital rim and then we cut
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the lateral canthal tendon this frees up
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the lower eyelid because we need to
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split it to open up an anterior and
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posterior lamella so that we can get to
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the tarsal plate and fashion a strip a
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new canthal tendon from the Tarsus and
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you see in portion D of this slide that
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tarsal strip being pulled towards the
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periosteum and attached we’ll use a
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four-oh Vicryl suture and then close the
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skin with a o nylon and having cut away
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the excess skin and here’s what someone
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can look like after they’ve had
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bilateral lateral tarsal strips again
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look to see where the lower eyelid
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is touching at the limbus and that just
:
tells you that this eye is in a much
:
better place than what is before surgery
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picture shows again we call the patient
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see how they’re doing
:
any questions any issues if we do need
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to see them we ask them to come in right
:
away so here’s a new question a lateral
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tarsal strip surgery is used to correct
:
punk tile stenosis obstructed meibomian
:
gland or a lateral canthal tendon laxity
:
or ISA trophy I have a few seconds to
:
answer that please alrighty
:
gold stars for everyone let’s look at
:
another problem of a lower eyelid and
:
again I’m first looking at this patient
:
and I see that the lower eyelid is not
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touching the limbus so something’s wrong
:
there whether it slacks you can even see
:
in his case these eyelashes are rolled
:
up against the conjunctiva and perhaps
:
even rubbing onto the cornea which gives
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a foreign body sensation causes tearing
:
and in this case the problem with
:
entropion is that the often times the
:
and the entire eyelid has a rotation
:
towards the globe indicates to me that
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the capsule o palpebral fascia has lost
:
its positioning to the lower eyelid
:
Tarsus and we need to reattach it in
:
this gentleman’s case there’s also lower
:
lid laxity so he’s going to have two
:
procedures combined in one surgery now
:
this gentleman does not take coumadin
:
but he’s diabetic and he uses insulin
:
that’s not a problem please take that as
:
you normally would your usual dose
:
please eat lightly that’s not a
:
restriction he does not use any
:
ibuprofen or aspirin he only likes
:
tylenol for discomfort he does
:
drink or use vitamin E and so you can
:
complete the checklist here and it says
:
written down for them to take with them
:
as well and on the day of surgery Keenan
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has his thumbs up we’re doing good he’s
:
had a light meal he did have his insulin
:
this morning
:
no blood thinners the eye is consented
:
and the eye is rather the eye is marked
:
and the consent is signed the vital
:
signs are stable and we’ve completed our
:
surgical safety checklist so we’ve also
:
we’ve called the eyelid muscles that
:
raise and lower the eye in the upper
:
eyelid and in the lower eyelid
:
retractors because they have specific
:
duties in holding the eyelids in place
:
and to raise and lower them so the
:
capsule o palpebral fashio is what we’re
:
going to go get and reattach we use
:
we’ve done our injection and made our
:
skin incision and we’re showing the
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retractors in the forceps this is a
:
better view of forceps holding the
:
retractors that we’re going to reattach
:
to the tarsal plate to correct that
:
rotation of the lower la eyelid into the
:
I will use a sick so fast absorbable
:
suture we place about six to eight of
:
them and then we’re going to continue
:
with the lateral tarsal strip that this
:
patient also needs so sometimes
:
surgeries need to be combined to repair
:
the malposition they’re having a sick so
:
fast observing suture was used to close
:
and we like to do our incision just
:
under the eyelashes because that
:
camouflage is the incision line and you
:
can see how nicely it’s healing up a
:
week later and look at that nice
:
position and tightness of the lower
:
eyelid and certainly it’s touching the
:
cornea limbus it looks still a little
:
swollen and that should come down but
:
that eye looks a lot more comfortable
:
phone call the next day to see how
:
things are any questions and life is
:
good
:
a pepero excessive watering so why is
:
the eye doing that is it because the
:
lacrimal gland is on hyper mode
:
operating or is there some obstruction
:
in the drainage system and in case of
:
this patient we’re looking at stenosis
:
maybe scarring of her punctum in the
:
first picture you can barely see any
:
type of punctum and in the screen on the
:
right you can see how the mouth of the
:
punctum is swollen irregular almost it
:
makes it difficult for the tear to enter
:
into there it can be due to repeated
:
probings use of glaucoma medications
:
such as a serine for example infections
:
such as herpes zoster and in short the
:
punctum can’t take the fluid in the tear
:
we’ve done our complete eye exam this
:
patient is perfectly healthy she doesn’t
:
take any blood thinners she does take
:
metoprolol for blood pressure that’s
:
fine take that on the day of surgery as
:
you normally would she only uses Tylenol
:
she doesn’t drink nor take any vitamin E
:
she satisfies and understands all the
:
questions here and instructions of what
:
to do what not to do the day of surgery
:
will Keenan’s got his thumbs up she’s
:
eating a light meal she takes she’s
:
taken her blood pressure medicine
:
metoprolol
:
and she’s got a good blood pressure
:
someone is there to drive her home she
:
is consented and the operative eye is
:
marked and we’ve completed our surgical
:
safety checklist the three snip punko
:
plasti is performed after we’ve injected
:
our local anesthetic and remember hold
:
your patients hand it is so comforting
:
and really does build some trust and
:
confidence that they’re glad they are
:
where they are the three snip panco
:
plasti is a rectangular or triangular
:
cutting in
:
– the pontem and you can see how it is
:
two vertical cuts with a horizontal and
:
the triangular cut is more invasive into
:
the horizontal canaliculi of a punctum
:
either way we’re trying to open the
:
punctum to allow more tears to enter and
:
to minimize secondary closure with
:
healing or scar tissue developing we’re
:
going to place a silicone stent and
:
we’re going to use a pigtail probe and
:
we use the probe to insert gently
:
through the upper punctum and rotate out
:
of the lower punctum it has an eyelet
:
that we thread a o prolene suture and
:
then rotate it back so now we have the
:
suture coming through both openings of
:
the punctum actually puncta is plural at
:
that point we’re going to trim the
:
prolene suture excuse me we’re going to
:
take the silicone instead it’s roughly
:
millimetres and apply a small amount
:
of antibiotic ointment and we’re going
:
to rotate that through the upper punctum
:
along the prolene suture to be in place
:
that it totally in circles the
:
canaliculi tract of the two punctum and
:
bring that silastic tubing together tie
:
the prolene into a knot trim the excess
:
silicone stent and cover it so that it
:
comes together enough to close over the
:
prolene knot
:
we then rotate that about degrees
:
into the common canaliculi area and it
:
remains there for about to weeks
:
the patient’s own tears will pass over
:
the tubing and they will come back and
:
have the silicone stent and prolene
:
suture removed we untie the knot at the
:
slit lamp and then we pull the tubing
:
and the
:
prolene out and hopefully that will
:
complete her problems with the pepero
:
permanently again we’re going to call
:
them the day after to see how they’re
:
doing are there any questions and deal
:
with what is happening for our patient
:
here’s the final question patients with
:
excessive tearing and blurry vision may
:
have a cataract and trophy on puntal
:
stenosis or entropion and puntal
:
stenosis seconds let us know what you
:
think all righty
:
gold stars for everyone it is punk tile
:
stenosis and entropion a cataract is
:
really not going to cause you to have
:
tearing and blurry vision I say yes to
:
the blurry vision but it’s not going to
:
have the tearing that’s the real clue
:
right here thank you so much so finally
:
we’re going to look at a unilateral
:
facial paralysis called Bell’s palsy it
:
affects the seventh cranial nerve we
:
don’t know why it happens we we blame
:
things on viral infections sometimes
:
this is associated with herpes or viral
:
meningitis but it can be traumatic like
:
a skull fracture and in the case of
:
Sylvester Stallone when his mom was
:
giving birth they had to use forceps to
:
help him be born and those forceps
:
damaged the left side of his face giving
:
him the paralysis and the features that
:
he has in the manner in which he speaks
:
so an inability to close the eyelid is
:
also called lockup Thomas there’s
:
drooping of the mouth there can be
:
drooling there can be ear pain and jaw
:
pain because the seventh cranial nerve
:
serves those organs as well
:
and it can just come on out of nowhere
:
it can last three to six months it can
:
be very transient or it can be permanent
:
here’s another actor with Bell’s palsy
:
and I did try to find a good picture of
:
Angelina Jolie with her episode of
:
Bell’s palsy but there aren’t any and so
:
for some patients the placement of a
:
gold wait is an option to help
:
completely close their eye these
:
patients are very tired of having to use
:
the artificial tears and ocular
:
lubricants as frequently as they have to
:
and so if the option of a gold wait is
:
viable for them we go for it one
:
drawback with the gold weight is that
:
the patient has to be aware that they
:
may have at otic eyelid after the gold
:
weight is placed
:
but for many that’s not the problem that
:
they’ve been living with in terms of
:
laga thalamus and the ocular discomfort
:
of an exposed cornea and eye gold
:
weights come in a variety of sizes .
:
to . grams they have a curvature to
:
fit the tarsal plate and they have three
:
holes that allow for the suturing to
:
attach them to the tarsal plate gold and
:
platinum can be used they are both inert
:
metals and well tolerated by the body
:
and the side view just shows how we’re
:
going to place it beneath the
:
orbicularis muscle to the tarsal plate
:
we’ll make a pocket and this young man
:
has had his gold weight three months and
:
doing well with his eye closure however
:
first our patients are going to have
:
their complete eye exam we’re going to
:
make sure there’s no other ocular reason
:
or medical history of sorts that needs
:
to be treated first and then we’ve
:
scheduling them for surgery we have done
:
a trial wearing of the gold way to
:
determine which one will be the best fit
:
for them we are completing our minor
:
surgery instructions this patient does
:
take a blood thinner she does not use
:
aspirin or any of these other products
:
she does drink wine so we’re gonna have
:
to wait weeks before we schedule her
:
for surgery and she’s willing to do that
:
she does not take any vitamin E and we
:
complete the rest of the instruction
:
sheet here and two weeks away surgery is
:
scheduled she has stayed away from her
:
wine she’s looking forward to it later
:
today and she has someone to drive her
:
home Keenan has the thumbs up she’s been
:
to the restroom she’s only used Tylenol
:
the eye is marked this consent has
:
signed her vital signs are stable and
:
we’ve completed our surgical safety
:
checklist we’ve marked the eyelid crease
:
but we’ve only we’re only going to open
:
a small section because we only need a
:
small pocket to fill with the gold
:
weight and the lidocaine has been
:
injected and you can see the gold weight
:
getting ready to be inserted and here it
:
is now tied into the pocket with LAN
:
suture will then close the obit eulerís
:
and then the skin the patient will use
:
an antibiotic ointment for the next week
:
we like for them to use a cool compress
:
immediately afterwards because we want
:
to minimize swelling and will aid in
:
discomfort and here are some patients
:
post gold weight placement who have
:
their before pictures and afterwards you
:
see nice closure you also really don’t
:
notice that they have a bulge or that
:
they’re wearing something on their upper
:
eyelid and certainly this gentleman look
:
at the amount of lag up Thomas there
:
that poor left eye is miserable and I
:
know that they had a lot of relief from
:
their surgeries so if the Bell’s palsy
:
resolves and we just remove the gold
:
weight and they now have a new piece of
:
jewelry
:
we’ll make our post procedure phone call
:
see what problems they’re having and if
:
they need to come in we’re certainly
:
going to have them do that well there
:
you have it
:
common oculoplastic procedures performed
:
in the minor AR i hope this information
:
will enhance your nursing care and take
:
your skills to another level of
:
expertise and do remember to hold the
:
patient’s hand while the local injection
:
is given it will comfort and reassure
:
them more than you now I’ll be happy to
:
answer any questions and thanks for
:
stopping by
:
thank you nurse sandy if you want to go
:
ahead and stop sharing your screen we’ve
:
done one Q&A question so far how do I
:
find stopping my stop share yep okay so
:
if you can open the Q&A box which is
:
right next to share screen yes so
:
there’s one question so far can you see
:
that yes I do
:
so like talk and answer yeah just like
:
that okay just move this here how much
:
lidocaine is enough well your surgeon
:
has going to have that expertise of when
:
they’re training and they’ll know how
:
much we generally use a three cc syringe
:
but we don’t necessarily have to inject
:
the whole cc ml it also depends on
:
your patient and type of surgery that
:
you’re doing where they’re not sensei
:
ting so when the patient does not feel
:
the needle touching their skin pointed
:
edge in to see if they feel that you’re
:
going to continue to give medication and
:
your surgeon will decide when enough is
:
enough thank you so that seems like the
:
only live question we had some questions
:
asked at the time of registration and
:
since we have about to minutes to
:
– maybe going through these sure
:
Vox out of here alrighty there were some
:
questions posted when y’all registered
:
and I’m looking at one that says I am
:
setting up an oculoplastic sner sled
:
clinic and wonder if you have any advice
:
my comments would be no your facility
:
depending if your hospital or a private
:
office what are the regulations that
:
your country or Medical Institute or
:
regulatory boards of your government
:
require you to be licensed as a
:
physician’s office I would certainly
:
look to the a ORN guidelines and look at
:
other facilities that have already been
:
set up because why work so hard when
:
somebody else has already gone down this
:
path you need to just network with
:
people to know what they did and be sure
:
those are the present guidelines in your
:
particular country next question here I
:
would like to know all the steps one by
:
one to all the surgeries and what we
:
need to prepare for all of the surgeries
:
well I think I’ve given you some ideas
:
for minor surgery procedures certainly
:
for oculoplastic the docs like point
:
three forceps a needle holder Westcott
:
scissors stevens scissors a blade handle
:
rakes double prongs and hook and that’s
:
about as far as I can go with that but
:
please look online to see samples of
:
things because you can build what you
:
would you discover as well as what the
:
preference are for your doctors and the
:
resources that you have available I’m
:
going to skip number four and I would
:
like to go to which of the country can I
:
get an offer for oculoplastic nursing
:
and management anywhere you want you
:
just have to go out there and look and
:
offer yourself up
:
good luck which stent do you prefer
:
for drainage issues I have no real
:
preference again it’s our surgeons we’re
:
using Crawford silicone stents Minooka
:
also makes products so again what you
:
can get that’s affordable and your
:
surgeons like to use that will be the
:
preference and
I’m not really understanding the glaucoma question and
:
I’m that wasn’t a topic we covered today
:
so I’d like to leave that reference book
:
yes there are some good ophthalmic
:
reference books and cyber site has one
:
of the ophthalmic practices for nursing
:
in or perioperative theater in lower
:
resource countries am i answering this
:
live here Laurence I’ll take care of
:
that okay and the next question I’m oh
:
good thank you because I can’t answer it
:
and here’s a question about when do you
:
use medial conjunctiva plasti well
:
whenever your surgeon feels like that’s
:
the correction that the patient needs
:
I’m not as fluent in that particular
:
procedure but that would be up to the
:
surgeon they know and have been trained
:
to correct the patient’s problem as
:
oculoplastic surgeons so you have to
:
trust what they’re dictating and wish to
:
do on a patient and help the patient to
:
understand how this procedure will
:
correct and go from there great thank
:
you nurse Andy so maybe we’ll give like
:
seconds to a minute there’s any final
:
questions thank you
:
:
all right so I think that’s it for today
:
thank you again there sandy and yep
:
thank you to everyone who joined right
:
have a good day
:
all righty y’all – bye-bye