Chapter 10: Advanced Ocular Procedures

INTRODUCTION

10.1 INTRODUCTION TO ADVANCED OCULAR PROCEDURES

Advanced ocular procedures are techniques that go beyond the standard or routine ophthalmic examination. These techniques are usually problem specific and performed by eyecare practitioners when clinically indicated. Many advanced procedures include manipulating ocular structures directly, performing minimally invasive surgical procedures (such as intralesional steroid injection and suturing), removing ocular foreign body (FB), and using anterior segment lasers. The following procedures in this chapter presume that the examiner is intimately familiar with and has mastered the prior procedures mentioned in the text. The goal of this chapter is to provide procedural knowledge on various advanced techniques, ophthalmic lasers, and microsurgical procedures used for treatment and management of ocular diseases.

A number of techniques described in this section involve instruments that are placed in direct contact with ocular surfaces or fluids. It is critical that these instruments be sterile or disinfected following the guidelines set forth by the Centers for Disease Control and Prevention (CDC) (or other local legal requirements if outside the United States), see Procedure 2.2, “Infection Control.” The examiner should also observe Standard Precautions whenever a procedure involves touching a patient, e.g., vigorous hand washing with soap and water before and after every patient encounter to prevent the spread of infection. Clear instructions given to the patient are also crucial in maximizing safety and accuracy.

Note: Procedures outlined in this chapter may require additional advanced training, privileges, and certification in order to perform them in the patient care setting; restrictions may be in place in certain states and jurisdictions. This text is not intended for any practitioner to use this book alone without the proper hands-on training of the techniques and post-procedural care and management training. Injection training, certification, and/or licensure is a prerequisite for all advanced procedures that require injections. The examiner should consult with regional authorities to ensure the proper training and credentials are obtained before performing these procedures in patient care.

10.2 PUNCTAL PLUG INSERTION (TEMPORARY SHORT DURATION INTRACANALICULAR COLLAGEN IMPLANT)

Purpose

The aim of this procedure is to determine if permanent punctal occlusion to treat ocular surface disease or increase drug retention time using temporary short duration intracanalicular collagen implants is effective for diagnostic purposes.

Indications

Some indications include moderate to severe dry eye disease, to increase drug retention time for ocular lubricants or other ophthalmic drugs, refractive surgery, contact lens wearers, and other ocular surface disease.

Contraindications

Contraindications to this procedure include allergy to bovine short ...