Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Ophthalmology
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Procedures
Regional anaesthesia, using a retrobulbar block (> 6 ml lidocaine) and a facial
block, is possible but general anaesthesia is preferred.
Incise the conjunctiva at its junction with the cornea using fine scissors and
continue until the cornea has been ‘circumcised’. Lift the conjunctiva from the sclera
using blunt dissection. Identify the four rectus muscles and capture them with a
muscle hook. Cut each muscle leaving a small stump attached to the globe. Repeat
for the obliques and free the globe from the fascial sheath using blunt dissection.
Draw the globe forwards and identify the optic nerve. Pass curved forceps behind
the globe and clamp the nerve. Cut between the globe and the forceps with curved
scissors. Do not tie off the nerve, apply gauze and pressure until the bleeding stops.
Close the fascial sheath first, using a purse-string suture, followed by the conjunctiva,
using simple interrupted sutures. Wash the socket with 0.5% chloramphenicol.
Apply a sterile pad and pressure bandage. Tetracycline 1% eye ointment should be
used daily for 8-12 weeks.
Acknowledments
We are grateful to Dr. Laji Varghese of Lady Willingdon Hospital for his support
and guidance. Many thanks go to Jasmin Devi for her expertise and assistance.
References
1. McMullen R, Jong E. The travel and tropical medicine manual. 2 nd ed. Philadelphia:
WB Saunders Company, 1995.
2. Collier J, Longmore M, Brown TD. Oxford handbook of clinical specialties. 5 th
ed. Oxford: Oxford University Press, 1999.
3. Cook J, Sankaran B, Wasunna AEO. General surgery at the district hospital. World
Health Organization 1998.
4. King M, Bewes P, Cairns J et al. Primary surgery, volume one. New York: Oxford
University Press, 1990.
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