1. Assisting in slit lamp examination (Applanation & Gonio)

2. Objective & Outcome Objective Outcome
Learning how to assist Gonioscopy, Applanation Tonometry, Suture removal and foreign body removal
Outcome
To prepare and assist well for said above procedures
Safe and effective maintenance of Applanation tip and Gonio lens

3. Indications for Gonioscopy
To identify the type of glaucoma
To find out abnormal deposits like PXF
To look for NVA
To identify angle FB, tumors of iris

4. Assisting in Gonioscopy evaluation
Wash the hands
Explain the procedure to the patient
Apply local anesthetic eye drops
Make the patient sit comfortably
Provide coupling gel whenever required
After completion of test, clean the lens with wipe or in running water
Wipe dry and store
Handle the lens with care as it is fragile and costly.

5. Goldmann Applanation Tonometry
Basic aspects:
Reliable and accurate measurement of IOP is possible
Universally accepted as a gold – standard method
Easy to perform after practicing
Requires a slit lamp to measure IOP

7. Assisting in Applanation Tonometry
Explain the procedure to the patient
Make the patient comfortable
Apply local anesthetic eye drops
Stain both eyes with Fluourescein
Wipe the excess stain
Instruct the patient to look straight

8. Do’s and Don’t
Applanation tip should be washed in running water / wipe dry
Don’t use spirit to clean gonio lens and applanation tip

9. Assisting in Corneo- scleral suture removal (CSSR)
Procedures for assisting in Corneo- scleral suture
removal:
Antibiotic drops should be instilled at least 4 to 5 times at 15 minute intervals prior to CSSR
Clean the slit lamp
Tray prepared with needle and forceps
Wash and dry the hands
Topical 5% providine iodine betadine eye drops to be instilled in the patient’s eye before suture removal
Local anesthetic drops should be applied

10. Suture Removal
Suture – cutting is done using 26 G disposable needle or with sterile blade.
Cut sutures are pulled and removed with sterile forceps
Antibiotic drops instilled after CSSR
Pad and bandage is applied (Not for monocular patient) after instilling antibiotic ointment

11. Suture Removal
All CSSR patients are advised to use antibiotic drops 4 times a day for 1 week and a to report back immediately if they develop pain and decreased vision
Forceps should packed for sterilization
Needles should be discarded
Instruct the patient to carry out doctor’s advice

12. Assisting in Foreign body removal
A corneal foreign body may consist of dust, iron particles, vegetable matter, or sand and mud particles
Multiple or loose foreign bodies can often be removed with saline irrigation
The foreign bodies can be removed with cotton – tipped applicator or with fine forceps

13. Procedures for assisting in foreign body removal
Apply local anesthetic eye drops
Encourage the patient to look straight ahead and to cooperate
Once the foreign body is removed either with a needle or cotton swab, apply a drop of antibiotic eye drop
Apply antibiotic ointment and cycloplegics eye drops if advised by doctor
Apply a sterile pad and bandage to the eye

14. Questions What are the uses of Gonio?
What are all the local anesthetic drops are available?
What are the uses of fluorescein staining?
What are the materials needed for suture removal?
How will you remove the corneal foreign body?

15. Thank you