Welcome to Main Theatres Ophthalmology Welcome to Main Theatres – Ophthalmology We hope you enjoy your placement in the department and benefit from your experience. We aim to provide a learning environment that is challenging and enables students to fulfil outcomes set by the university. A mentor is allocated to each student to guide you through your learning outcomes and will regularly review your progress. Please don’t hesitate to provide any feedback or concerns you may have regarding your placement. Department Profile Our department consists of two operating theatres which cater for both in-patient and day case surgery. Both theatres operate Monday to Friday from around 8:30 am to 5:30 pm. All types of ophthalmic surgery are performed within the department including :- - vitreo-retinal surgery - paediatric ophthalmic surgery - strabismus (squint) surgery - lid surgery - corneal surgery - cataract surgery - oncology surgery - emergency surgery e.g. penetrating injury , lid laceration PHILOSOPHY OF CARE We believe each individual should receive a holistic approach to care which accounts for physical, psychological and cultural needs. Care should be offered in a clean, safe environment and delivered in a courteous, professional manner. Confidentiality, privacy and dignity should be respected at all times through practice within the professional code of conduct. We aim to improve patient care through life-long learning, audit and evidence based practice and so offer patients informed choices in their care. Each patient will have his or her own Named Nurse responsible for assessing, implementing and co- ordinating care within the multi-disciplinary team. By use of a problem solving, patient focused approach to care, we hope to build a partnership of care that aims to help patients attain, maintain and restore health. We aim to develop our role as educators and provide a supportive environment where learning is encouraged for all staff, patients and carers. There are 13 different consultant ophthalmologists who operate regularly in our department : - Mr Inglesby : vitreo-retinal surgery - Mr Fetherston : vitreo-retinal surgery - Mr Steele : vitreo-retinal surgery - Mr Morgan : corneal surgery - Mr Bell : corneal surgery - Mr Danjoux : corneal surgery - Mr Boyce : lid and plastics surgery - Miss Chapman : lid and plastics surgery - Mr Tiffin : paediatric ophthalmic surgery - Mr Gnanaraj : paediatric ophthalmic surgery - Mr Allchin : strabismus (squint) surgery - Mr Fraser : glaucoma surgery - Mr Wood : ophthalmic oncology surgery There are 2 other surgeons who specialise in fast track cataract surgery. - Mr Phelan - Mr Allen Both of these surgeons are based in Cataract Treatment Centre and only operate in our theatres on emergency cases. Most patients operated on within the department are in-patients from Haygarth Ward and usually require a general anaesthetic. We also perform day case surgery under local anaesthetic, usually for patients requiring lid surgery e.g. for an in-turning eyelid (entropian). Some of our staff have an ophthalmic nursing qualification and training for those who don’t is encouraged when opportunities arise. Research is also encouraged from both nursing and medical staff to improve and update current practice. Primary Nursing Patients visiting theatre from Haygarth ward are allocated their own primary nurse on arrival. This nurse will then be responsible for the patients care during their entire stay in the department. The same method is adopted for patients attending the department as day case patients. Each consultant is also allocated their own primary nurse who is responsible for co-ordinating the care and nursing team when they operate in the department. The consultant also liases directly with their primary nurse to ensure all requests , equipment etc are satisfied. MAIN THEATRE : Nursing Staff Kath Stoddart – Department Manager Kath Yates - paediatric link/leaflet link Team One Dorothy Arrowsmith (oncology /control infection) Clare Smith Santy Nocon (clinical supervision/manual handling) Bettsy Juan (health and safety) Rodel Tirados (control of infection) Elsa Joseph Maria Manuel Paul Dean Team Two Steve Dodds (Hiss/clinical supervision /Education) Maureen Waites (COSHE/CPR) Michelle Dunn (NVQ/education) Raj Boyjonauth Beena Toji Sahlee Alonzo Nicola Taylor Pauline Price O.D.P. Trevor Duell Theatre Timetable 2006 Monday Am Th. 1 Mr Tiffin Paediatrics Th. 2 Mr Morgan Corneal/Mix Monday Pm Th. 1 Mr Fraser Cataract/Glaucoma Th. 2 Vitreo-retinal Emergency List Tuesday Am Th. 1 Miss Chapman Lids/Plastics Th. 2 Mr Steel Vitreo-retinal Tuesday Pm Th. 1 Mr Allchin Strabismus Th. 2 Mr Boyce Lids/Plastics Wednesday Am Th. 1 Mr Allchin Strabismus Th. 2 Mr Inglesby Vitreo-retinal Wednesday Pm Th. 1 Mr Allchin Strabismus Th. 2 Mr Steel Vitreo-retinal Thursday Am Th. 1 Mr Fetherston Vitreo-retinal Th. 2 Mr Gnanaraj Paediatric/Mix Thursday Pm Th. 1 Mr Boyce Lids/Plastics Th. 2 Mr Morgan Corneal/mix Friday Am Th. 1 Mr Boyce Lids/Plastics Th. 2 Mr Inglesby Vitreo-retinal Friday Pm Th. 1 Miss Chapman Lids/Plastics Th. 2 S.R. Minor Ops Hours of Duty Full time staff are required to work Monday to Friday and do three 8 – 5:30 shifts and two half days. Start and finish times are flexible when necessary either staff or the department. Normal shift times are as follows : - full day, 08:00 til 17:30 - half day, 0800 til 13:00 or 13:30 - reverse half day, 12:30 til 17:30 As we are a Monday to Friday area only , there are usually no difficulties in working your minimum of 50% of shifts with your mentor. If you are off sick at any time, remember to inform both us and your university. There are also always two members of staff on-call for out of hours emergency cases. Useful Telephone numbers Office Extension 46281 Direct Line 0191 569 9156 Line Extension 46280 Coffee Room 46283 Sister’s Office 46282 Emergency Alarm Calls And Numbers Fire Alarm Every Thursday morning the fire alarm sounds an intermittent tone at around 11:45 am. This is the test procedure. If this sounds at any other time it indicates a real fire alarm and action must be taken. All doors and windows are to be closed and remain so until the all clear is given. A continuous tone indicates a fire alarm in your area and immediate investigation is required and possible evacuation of all patients, relatives and staff. Crash Call In the event of a cardiac arrest in the department the first action is to put out a crash call and shout for assistance. The crash trolley is located in the recovery area of theatres. Cardiac Arrest : 2222 Fire : 333 Security : 777 Ophthalmology Definition The study of the eye and its associated parts. Ophthalmology deals with diseases of the eye and their treatment. The word ophthalmology has greek roots derived from the greek words ophthalmos meaning eye and logos meaning word. So its literal meaning is ‘the science of eyes’. Anatomy of the Eye Ophalmology is constantly changing and updating as research and technology offer continually improving treatments and equipment. During your placement you will have the opportunity to observe a wide variety of ophthalmic surgery in our department. The following is a brief introduction to the types of surgery performed in this department. Cataract A cataract is a misting or opacity of the lens. It prevents light entering the eye properly and causes dimness of vision and eventually blindness if left untreated. Most cataracts are caused by the body’s normal ageing process but occasionally are caused by trauma, diabetes or drugs.The cataract can be removed by an operation called phacoemulsification (see below). The lens is broken down using ultrasonic vibrations then aspirated. A plastic lens implanted inside the eye (IOL - intra ocular lens) then replaces the cataract (see below). Sutures are not usually needed and the patient can return to a normal lifestyle immediately afterwards. Trabeculectomy Indicated for patients with glaucoma. The operation is performed where prophylactic treatment fails to control the intra ocular pressure (IOP). The aqueous fluid of the anterior chamber, in the front part of the eye, is unable to drain sufficiently away due to a blockage in the drainage channel, the trabecular meshwork, located at the junction between the sclera and the cornea. Trabeculectomy involves creating a thin scleral flap and internally cutting two small holes, one in the iris (an iridectomy) and the other in the drainage channel, usually at 12 o’clock to be less noticeable under the eye lid. This allows the aqueous fluid to flow freely and gradually be absorbed by the bloodstream and so lowering the intra ocular pressure. Lid Surgery Ptosis A ptosis is a drooping of the upper lid. It can be caused by: - - Abnormal weight on the lid due to oedema, tumour or scarring - trauma or disease to the muscle - paralysis of nerves supplying the upper lid - congenital causes A ptosis can be corrected by lid surgery during which the levator muscle in the lid is resected. Entropian Is a turning in over of the eyelid due to weakness of the lid retractors (the muscles which open and close the eyelids). Usually occurs in the lower eye id causing eye to water and eyelashes to rub against the cornea causing pain and discomfort. There are many different operations to correct entropian but all usually involve removing part of the eyelid therefore tightening the retractor muscle and shortening the lid. Ectropian Is a turning out over of the eyelid due to a weakness of the orbicularis muscle. Usually occurs in the lower eye lid and causes the eye to water constantly because the drainage hole (punctum) is not in the correct position. The most common operation is to shorten the eyelid and to enlarge the punctum to reduce watering. Lid Lesions - Removal Usually performed to remove a lesion for diagnostic purposes. If results indicate a carcinoma further surgery will be required to remove it and re-construct the eyelid. Some lid lesions may also be removed for cosmetic reasons. Chalazion The Meibomian glands are found in the eyelids and produce a sebaceous substance, which creates the oily layer of the tear film. A chalazion occurs when one of the Meibomian glands swell due to a blockage of its duct. If the swelling does not subside the chalazion can be removed by incision and curettage. A clamp is placed on around the chalazion and the eyelid everted. A small incision is made and the contents scooped out using a curette. The clamp is then removed and some anti- biotic ointment and a firm pad are applied. Evisceration Removal of the contents of the eye, usually after an infection has left the eye blind. A small amount of eye movement is retained after this surgery giving a more cosmetically pleasing result. Enucleation Removal of the whole eyeball leaving the extra ocular muscles. The socket is fitted with a conformer to enable a good cosmetic result with a prosthesis (fitted at a later date). It is often performed as a last stage of treatment for a painful, blind eye following malignant melanoma. Dacryocystorhinostomy (DCR) Epiphora, or watery eyes, occurs because of a blockage in the normal lacrimal drainage system, which impairs normal tear channelling into the nasal cavity. Recurrent infection or dacryocystitis may occur as a result of stagnation. DCR may alleviate symptoms and involves surgical creation of a new passage of drainage for tears into the nasal cavity. Vitrectomy and Detachment Surgery These operations are performed for patients who have problems with their retina often associated with diabetes, short-sightedness (myopia) or trauma. The operations are often intricate and lengthy procedures. Vitrectomy (internal approach) involves removing the jelly part of the eye (vitreous) and replacing it with a fluid containing minerals and salts and is about the same consistency as the aqueous fluid of the anterior chamber. Microsurgery is then performed to attempt to rectify the specific problem such as retinal holes, tears or membranes. Detachment (external approach) is performed on the outside of the eye (sclera) and involves suturing a silicone explant onto the sclera to create an indentation of the detached area of retina. A freezing process (cryotherapy) is then applied over the sclera to induce an inflammation over the retinal problem. The inflammation will gradually subside taking the retina back to its normal position and up against the indentation of the explant. Occasionally a gas bubble is (SF6 or C3F8) mixed with filtered air is injected into the eye to tamponade problem retinal areas. The gas bubble will expand a little inside the eye and push up against the retina and help keep it in place. The gas bubble is gradually absorbed. Patients may need to posture post- operatively to help with the success of the operation i.e. lie in a certain position so gas bubble tamponades the right area of retina. The posturing can be said to be as important as the surgery itself. Corneal Graft A corneal graft is a transplant operation involving removal of the central part of the cornea and its replacement with a cornea from a donor. The donor cornea comes from someone has expressed a wish that their corneas be used to help someone else see after their death. The donor cornea is sutured to the host using either a series of interrupted sutures or one continuous suture. The sutures may be left in place for up to two years. Although rare, corneal rejection is a post op complication and can occur even years after surgery. Rejection occurs most commonly in the first year after surgery. LEARNING ZONES Pre-admission Assessment Clinic Almost all elected patients are assessed prior to admission within one month of their surgery date, investigations are undertaken, eg tonometry, venepuncture, electrocardiograph, focimetry. Physical and social needs are taken into consideration and social services, occupational therapists or district nurses may be required for input on discharge from hospital. These services can be organised before admission,. The patient can receive information about their forthcoming surgery here. Haygarth Clinic Specialised nurse-led clinics are undertaken here, eg blood monitoring, oculoplastics. Patients attend as outpatients. Consultant Ophthalmologists also hold regular clinics here. Cataract Treatment Centre Patients are assessed prior to day case surgery, nurses prepare the patient for surgery and surgery such as cataracts under local anaesthetic and other eye operations are carried out and the patient is usually discharged the same day. Nurses carry out a post-operative telephone assessment on the first post-operative day. Patients are also seen as outpatients by Consultants and listed for surgery as well as reviewed one-two weeks post-operatively. Main Theatre / Day Case Unit Again, patients are assessed prior to day case surgery. Patients undergo surgery for all manner of eye problems under general and local anaesthetic, eg vitrectomy, squints, cataracts, trabeculectomies. Nurses carry out a post-operative telephone assessment on the first post-operative day. Accident and Emergency Patients attending the department are triaged into one of three categories. 1 = ocular emergency 2 = urgent 3 = non-urgent The patient will be seen by the nurse practitioner, the nurse consultant, or the doctor, who can carry out the ocular examination and treatment. Conditions can include chemical injury, embedded corneal foreign body, arc eyes, eyelid lacerations, penetrating injuries, conjunctivitis etc. A minor operating theatre exists for small repairs/excision of chalazions and injection of botulinum toxin injections. Diagnostic Unit Ocular ultrasound is undertaken, as well as laser treatment and fluorescein angiograms on in-patients and out-patients as needed. Medical physics investigations can be done also. The glaucoma unit also carries out tests here Excimer Laser Unit Patients undergo refractive surgery here carried out by the Corneal Consultants. Out-patients Visual acuity is checked at each visit and doctor in the clinic sees the patient. Adult and paediatric clinics are held here. Orthoptic Department - Orthoptists measure for straight eyes. Pharmacy Dispensing of in and out patient prescriptions. Opportunity to observe the working of the pharmacy department and the various types of medications available. Profile of Learning Opportunities Learning Opportunity Resource / Relevant Personel / Department Use Of Telephone - making calls - answering calls - ring back facility Theatre Nursing Staff - awareness who to report to - bleep system Using HISS / Computers - patient admission profiles / information Theatre Nursing Staff - order entry - retrieve results - internet Library Staff - email access Participation - patient care Nursing and medical staff - MDT MDT members Patient Care - prioritising patient needs - different methods of care delivery e.g. primary nursing, named nursing, nursing caseload - observation skills e.g. BP, temeperature, pulse, ECG, blood glucose, INR, urinalysis - accurate documentation e.g. early warning scores, theatre register Theatre Nursing Staff - instillation eyedrops Anaesthetist - A-scanning Medical Staff - IOP measurement ODP’s - Scrubbing for ophthalmic surgery - Circulating (floor) nurse - Recovery of patients including airway management, monitoring oxygen saturation, administration of oxygen, IV therapy - Pain relief Infection Control - policies Theatre Nursing Staff - source and spread of Infection Control infection Department - aseptic technique Infection control link - appropriate nurse equipment,clothing Oncology - epidemiology / Theatre Nursing Staff aetiology Ward Nursing Staff - treatment Ophthalmic Oncology - surgery – radioactive Specialist – Mr Wood plaque - isolation nursing Ophthalmology Eye Infirmary Nursing - anatomy of eye Staff - diseases e.g.cataract Learning Zones e.g. CTC, - treatment Haygarth, OPD, A+E - surgery Medical Staff - ophthalmic pharmacy Pharmacist - pre-assessment Outpatient B : pre- - oculoplastics assessment - nurse led post op clinics - nurse led glaucoma clinics - outreach clinics Health Promotion - patient education All Nursing and Medical - health promotion Staff literature Smoking Cessation Advisor - smoking cessation LVA unit - low visual aids Communication Skills - assessment / Theatre Nursing Staff discussion / education Pre-assessment Nursing patients and relatives Staff in CTC and Haygarth - interviewing / Ward questioning skills during assessment Managing care - nursing process - philosophy of care - admission day case patients - assessment e.g. who assesses, how, what and where Nursing Staff - planning of care - computerised care plans - implementation of care - evaluation of care - discharge patients - referrals to members MDT - risk assessment tools e.g. EWS GLOSSARY OF OPHTHALMIC TERMS Abduction Turning the eye outwards. Acanthamoeba A genus of free-living amoeba. Accommodation The ability of the lens to change shape to allow near objects to be focused on the retina. Adduction Turning the eye inwards. Amblyopia Reduced vision usually due to interference with the eye’s development. Alpha, Gamma and Kappa Different angles in the eye measured between the optic axis and the visual axis. Aniridia Absence of the iris. Aphakia Absence of the lens. Applanation tonometry Measurement of the intra-ocular pressure by flattening the cornea. Arcus senilis Degenerative change in the cornea resulting in a white ring around the corneal circumference. Argon laser Laser that uses photocoagulation. Astigmatism Uneven curvature of the cornea. Binocular vision Co-ordinated use of both eyes resulting in a single vision. Biometry Measurement of the axial length of the eye. Blepharitis Inflammation of the lid margin. Blepharospasm Painful involuntary spasm of the eyelids. Blind spot Optic disc where there are no nerve endings, only nerve fibres. Bullous keratopathy Oedema of the cornea causing ‘blister’ formation in the epithelium. Canthus Outer and inner areas where the upper and lower lids meet. Capsulotomy Opening of the capsule of the lens. Cartella shield Plastic shield to protect the eye. Caruncle Small fleshy area in inner corner of the eye. Cataract Opacity of the lens. Central field/vision Area of vision when looking straight ahead. Chalazion Meibomian gland cyst. Internal hordeolum. Chemosis Oedema of the conjunctiva. Chlamydia Chronic conjunctivitis caused by serotypes D-K of Chlamydia trachomatis. Commotio retinae Oedema of the retina following trauma. Concave lens A lens which diverges light rays, used to correct myopia: a ‘minus’ lens. Concretion Lipid deposit in the conjunctiva. Convex lens A lens which converges light rays, used to correct hypermetropia: a ‘plus’ lens. Cycloplegia Paralysis of the ciliary muscles. Cylindrical lens A lens of cylindrical shape, which refracts light rays in various directions in different meridians, used to correct astigmatism. Dacryoadenitis Inflammation of the lacrimal gland. Dacryocystitis Inflammation of the lacrimal sac. Dacryocystorhinostomy An operation to make a passage from the lacrimal sac into the nose to overcome obstruction. Dendritic ulcer A branching ulcer of the cornea caused by the herpes simplex virus. Descemetocele Protrusion of Descemet’s membrane through the stroma and epithelium of the cornea. Dioptre Unit of measurement of strength of the refractive power of the eye, or lenses, expressed as a fraction of a metre. Diplopia Double vision. Disciform keratitis Inflammation of the cornea as a complication of herpes simplex virus. Distichiases Double row of eyelashes. Drusen Small yellow nodule in Bruch’s membrane or optic nerve. Ectropion Turning out of the eyelid. Electroretinogram A recording of electrical activity of the retina. Emmetropia Absence of refractive error. Endophthalmitis Inflammation/infection of inner structures of the eye. Endophthalmos Displacement of the eyeball downwards. Entropion Turning inwards of the lid margin. Enucleation Removal of eyeball and length of optic nerve. Epicanthus Broad fold of skin in inner canthus. Epilation Removal of an eyelash. Epiphora Watering eye. Episcleritis Inflammation of the episcleral vessels. Evisceration Removal of the contents of the eyeball, leaving the sclera intact. Excimer laser Laser used for corneal surgery, eg for correcting refractive errors or removing corneal scars. Exenteration Removal of the contents of the orbit, including the eyeball and lids. Exophthalmometer Instrument for measuring the degree of protrusion of an eye. Exophthalmos Protrusion of one or both eyes - usually refers to that caused by thyroid eye disease. Field of vision The entire area that can be seen without moving the eye. Fields of gaze The different areas that can be seen when moving the eye in all directions. Fixation The eyes are fixed on an object centrally at a chosen distance. Floaters Small, dark particles in the vitreous. Fundus Posterior aspect of the retina including the optic disc and the macula. Fusion Co-ordinating the images seen by both eyes into a single image. Glaucoma Increased intra-ocular pressure sufficient to damage vision. Gonioscope A contact lens mirror used to view the anterior chamber angle. Guttae (G.) Eyedrops. Hemianopia Half-vision - unilateral or bilateral. Heterochromia Difference coloured irises in one person. Hordeolum - internal See Chalzion - external See Stye Hypermetropia Long sight. Hyphaema Blood in the anterior chamber. Hypopyon Pus in the anterior chamber. Injection Degree of redness of the conjunctiva. Interpupillary distance(IPD) The distance between the two pupils. Interstitial keratitis Inflammation of the cornea due to syphilis. Iridectomy Removal of a piece of the iris. Iridodyalysis Severance of the iris from the ciliary body. Iridodonesis Quivering of iris following intra-capsular cataract extraction. Iridotomy A hole in the iris, usually performed by the laser beam. Iris bombe Bulging forward of the iris. Iris prolapse A section of the iris prolapsing through a wound, either surgical or traumatic. Iritis Inflammation of the iris. Ishihara colour plates Multi-coloured charts for testing colour vision. Keratitic precipitates Plaques of protein adhered to the corneal endothelium in uveitis. Keratitis Inflammation of the cornea. Keratoconus Conical-shaped deformity of the cornea. Keratometer Instrument for measuring the curvature of the cornea. Lacrimation Production of tears. Lagophthalmos Incomplete closure of the eyelids. Lamellar graft Partial thickness corneal graft. Laser Light Amplification by Stimulated Emission of Radiation. Energy transmitted as heat. Microphthalmos Small eyeball. Miotic Drug that constricts the pupil. Mydriatic Drug that dilates the pupil. Myopia Short sight. Oculentum (Oc.) Eye ointment. Operculum A semi-circular tear in the retina, covered with a flap of retina. Ophthalmia neonatorum Severe conjunctivitis of the newborn. Ophthalmoplegia Paralysis of the extra- ocular muscles. Ophthalmoscope Instrument for examining the retina. Optic axis The line through the centre of the optical structures of the eye. Palpebral Pertaining to the eyelids. Pannus Neovascularisation of the cornea. Panophthalmitis Inflammation of the whole eyeball. Penetrating graft Full-thickness corneal graft. Perimeter Instrument for measuring the field of vision. Peripheral vision/field Area of vision outside central field of vision. Phacoemulsification Removal of a cataract by ultrasound, breaking down lens matter prior to it being aspirated. Phasing Regular frequent measurements of intra- ocular pressure over a few days. Phlyctenule Small vesicle of allergic origin on limbal area of conjunctiva and/or cornea. Photophobia Sensitivity to light. Photopsia Sensation of flashing lights. Phthsis bulbi Shrunken eyeball. Pinguecula A yellowish overgrowth of conjunctiva. Placido’s disc A disc with alternating black and white rings for reflecting onto the cornea to detect any irregularity in its curvature. Presbyopia Inability to focus for near sight due to hardening of the lens nucleus after the age of 40 years. Preseptal callulitis Inflammation of preseptal portion of the eyelids. Prism A triangular-shaped lens used to correct diplopia. Proptosis Protrusion of the eyeball. Pterygium A triangular proliferation of conjunctival tissue that can invade the cornea. Ptosis Drooping eyelid. Refraction (1) Bending of light rays. (2) Measurement of and correction of refractive errors of the eye. Refractive surgery Corneal surgery to correct refractive errors. Retinal detachment Separation of the epithelial layer of the retina from its neural layers. Retinitis pigmentosa An hereditary degeneration of the retina. Retinoblastoma Highly malignant tumour of the retina in infancy. Retinopathy Non-inflammatory disease of the retina. Retinopathy of prematurity A vasoproliferative retinopathy occurring in premature infants. Retinoscope Instrument for objective assessment of refractive errors. Retrobulbar Behind the eyeball. Retropunctal cautery Cautery applied behind the punctum to cause fibrosis and inturning of the lower lid. Rhodopsin Light-sensitive pigment of the rods in the retina - ‘visual purple’. Rodding of fornices Passing a glass rod in either fornix. Rubeosis irides Neovascularisation of the iris. Scleritis Inflammation of the sclera. Scleromalacia Degeneration of the sclera. Scotoma An area of visual loss in the visual field. Seidel test A test to ascertain leakage of aqueous through a section or perforative wound using fluorescein drops. Sjorgen’s syndrome Syndrome comprising arthritis, dry eyes, dysphagia and achlorhydria. Snellen chart A chart consisting of graded letters, symbols or numbers for testing central vision. Squint Strabismus - deviation of one eye. Staphyloma A protrusion of the cornea or sclera. Stereopsis Perception of depth with binocular vision. Stevens-Johnson syndrome Acute mucocutaneous vesiculobullous disease. Strabismus See Squint. Stye Inflammation of one lash follicle. External hordeolum Superficial punctuate keratitis Superficial spots of inflammation of the cornea which stain with G.fluorescein. Symblephron Adhesion of the bulbar and palpebral conjunctiva. Sympathetic ophthalmitis Severe uveitis in one eye following trauma involved the uvea of the other eye. Synaechiae Adhesion of the iris (a) to the lens - posterior synaechiae; (b) to the cornea - anterior synaechiae. Tarsorrhaphy Suturing together of the eyelids. Tear film The film of liquid covering the eyeball. Tenon’s capsule Membrane encircling globe from limbus to optic nerve overlying the sclera. Tomography Computerised scan of the optic disc. Tonometer Instrument for measuring intra-ocular pressure. Topography A contour map of the curvature of the cornea. Toric contact lens Contact lens to correct astigmatism. Trachoma Potentially blinding infection of the conjunctiva and cornea caused by the TRIC virus. Trichiasis Ingrowing or inturning of eyelashes. Uveitis Inflammation of the uveal tract. Visual acuity Detailed central vision. Visual axis The line between a point viewed and the macula. Visual field Area of vision. Vitrectomy Removal of vitreous. Xanthelasma Fatty deposits on the eyelids. Xerophthalmia Lack of vitamin A resulting in corneal and conjunctival disease. Yag laser Laser that cuts holes in structures. Orientation Checklist To be completed as soon as possible Checklist Student Mentor Given student booklet Preliminary interview Identify learning needs Department tour Hospital / learning zones tour Introduction to staff Procedures for :- Cardiac arrest Fire Security Location of CHS policy files Awareness of policies Location education files University and CHS sickness policy Answering telephone / messages Location off duty file / requests Hours of duty / shifts Main Theatre / Day Case Unit Ophthalmology Placement Evaluation Form Date of placement :_____________________ Mentor Name :_______________________ 1. Were you allocated a mentor on arrival to the department ? 2. Were you orientated to the area ? 3. Did you work at least 50% of your shifts with your mentor ? 4. Did you feel adequately supported during your placement ? 5. Did you achieve the competencies required by the university ? 6. Did you access any of the learning zones during your placement ? 7. If not , can you explain why not ? 8. Was the portfolio of learning opportunities helpful ? 9. Do you feel the placement has taught you any new skills ? 10. How could we have improved your placement ?
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