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Irrigating Eyelid Speculum
VOL. 96, NO. 4
LETTERS TO THE JOURNAL
dies are interchangeable so that needles of different diameters as well as curved nee dles can be mounted on the handpiece. In the original vacuum-cleaning flute needle, the egress of fluid is controlled by the surgeon's forefinger over the exit port on the side of the handle. The dis advantage of this instrument is that it is not possible to backflush, so disengage ment when unwanted tissue enters the tip of the needle is impossible. To over come this disadvantage, a flute syringe with a backflushing capability was de veloped. 1 We have now constructed a modified flute needle with a backflushing capability. In the handle of the instrument, a small piece of silicone tubing with an exit port in the middle is connected to the needle (Figure). The exit port is controlled by the surgeon's forefinger. With the orifice open, the fluid flows out freely; when it is closed, the flow stops. Pushing forces the liquid in the tubing back through the needle, thus pushing out unwanted tis sues. Retina or vitreous inadvertently en gaged in the needle can be disengaged from the tip easily, making the instru ment safe for controlled internal drainage of subretinal fluid. We use 20-gauge and 22-gauge needles depending on the size of the retinal hole used for internal drainage. We also use a bent 20-gauge needle (20 to 25 degrees) to drain centrally accumulated subretinal fluid through a peripheral hole in the
549
retina; we then insert the needle into the hole and move it slowly under the retina in the direction of the collected subreti nal fluid. After drainage we withdraw the needle with the exit port closed. This allows us to drain all residual fluid with out making a new hole. The instrument can also be used as a tool. In extensive vitreoretinal surgery, such as for giant tears with proliferative vitreoretinopathy, we use it to reposition the retina on the choroid. We deliberate ly suck in the edges of the torn retina and reposition the retina on the choroid. When the retina is in the right posi tion, we disengage it from the tip by pushing on the silicone tubing. We use this method primarily in combination with intraocular silicone oil because the detached retina with proliferative vitreoretinopathy has a tendency to fall back unless supported by an intraocular tamponade. REFERENCE
1. Escofiery, R. F., and Grand, M. G.: A flute syringe for vitreous surgery. Arch. Ophthalmol. 98:2059, 1980.
IRRIGATING EYELID SPECULUM K I R K R. W I L H E L M U S ,
M.D.
Cullen Eye Institute, Baylor College of Medicine, 6501 Fannin St., Houston, TX 77030
S
*PB^^
^j^aiMiil^MMai Figure (Zivojnovic and Vijfvinkel). The modified flute needle. Top, Disassembled pieces. Bottom, The assembled needle.
Surface lavage of the eye is important after chemical injury as well as during ocular surgery in order to maintain corneal lubrication and clarity.1 Continuous ir rigation can also deliver topical medica tions to the cornea and conjunctiva. I have designed an irrigating eyelid speculum that can be attached to a sy-
550
AMERICAN JOURNAL OF OPHTHALMOLOGY
OCTOBER, 1983
BILATERAL GLAUCOMA CAUSED BY NASAL CARCINOMA OBSTRUCTING S C H L E M M ' S CANAL B R U C E L. J O H N S O N ,
M.D.
Eye Pathology Laboratory, Eye and Ear Hospital, 230 Lothrop St., Pittsburgh, PA 15213
Figure (Wilhelmus). Eyelid speculum with three irrigating portals on each retracting arm (arrows).
ringe or infusion bottle for continuous irrigation of the globe (Figure). Further modifications of the size, location, and direction of the irrigating portals can en hance its potential use in the operating room or emergency center. REFERENCE
1. Elsby, J. M.: Irrigating speculum. Br. J. Ophthalmol. 52:356, 1968.
Carcinoma metastatic to the eye has been recognized with increasing frequen cy in recent years. In almost all cases the predominant site of métastases is arterial embolization to the choroid. 1,2 In the larg est reported pathology series, only 26 of 227 patients (11%) with ocular métastases had the anterior segment as the predomi nant site. 3 My case demonstrated an un usual pattern of venous thrombosis by a nasal squamous carcinoma with glaucoma resulting from tumor obstruction of the canal of Schlemm and intrascleral and episcleral collector channels. A 74-year-old man with chronic lymphocytic leukemia was hospitalized be cause of maxillary facial pain. Radio graphs showed bilateral maxillary opacification suggesting maxillary sinusi tis. Examination of the nose disclosed large bilateral ulcerated and indurated areas of the septal mucosa. A biopsy specimen of the nasal septum disclosed an infiltrative, moderately well differen tiated squamous carcinoma. Radiation therapy was begun on an outpatient basis, but the patient was rehospitalized four weeks later with severe periorbital and nasal pain. An ophthalmic examination disclosed marked periorbital edema with conjunctival chemosis, injection, and scattered perivascular bulbar conjuncti val hemorrhages. Visual acuity was R.E.: 20/60 and L.E.: 20/80. The intraocular pressure was R.E.: 34 mm Hg and L.E.: 31 mm Hg. The anterior chamber angle was open bilaterally. Slit-lamp examina tion of the anterior segment showed only
LETTERS TO THE JOURNAL
dies are interchangeable so that needles of different diameters as well as curved nee dles can be mounted on the handpiece. In the original vacuum-cleaning flute needle, the egress of fluid is controlled by the surgeon's forefinger over the exit port on the side of the handle. The dis advantage of this instrument is that it is not possible to backflush, so disengage ment when unwanted tissue enters the tip of the needle is impossible. To over come this disadvantage, a flute syringe with a backflushing capability was de veloped. 1 We have now constructed a modified flute needle with a backflushing capability. In the handle of the instrument, a small piece of silicone tubing with an exit port in the middle is connected to the needle (Figure). The exit port is controlled by the surgeon's forefinger. With the orifice open, the fluid flows out freely; when it is closed, the flow stops. Pushing forces the liquid in the tubing back through the needle, thus pushing out unwanted tis sues. Retina or vitreous inadvertently en gaged in the needle can be disengaged from the tip easily, making the instru ment safe for controlled internal drainage of subretinal fluid. We use 20-gauge and 22-gauge needles depending on the size of the retinal hole used for internal drainage. We also use a bent 20-gauge needle (20 to 25 degrees) to drain centrally accumulated subretinal fluid through a peripheral hole in the
549
retina; we then insert the needle into the hole and move it slowly under the retina in the direction of the collected subreti nal fluid. After drainage we withdraw the needle with the exit port closed. This allows us to drain all residual fluid with out making a new hole. The instrument can also be used as a tool. In extensive vitreoretinal surgery, such as for giant tears with proliferative vitreoretinopathy, we use it to reposition the retina on the choroid. We deliberate ly suck in the edges of the torn retina and reposition the retina on the choroid. When the retina is in the right posi tion, we disengage it from the tip by pushing on the silicone tubing. We use this method primarily in combination with intraocular silicone oil because the detached retina with proliferative vitreoretinopathy has a tendency to fall back unless supported by an intraocular tamponade. REFERENCE
1. Escofiery, R. F., and Grand, M. G.: A flute syringe for vitreous surgery. Arch. Ophthalmol. 98:2059, 1980.
IRRIGATING EYELID SPECULUM K I R K R. W I L H E L M U S ,
M.D.
Cullen Eye Institute, Baylor College of Medicine, 6501 Fannin St., Houston, TX 77030
S
*PB^^
^j^aiMiil^MMai Figure (Zivojnovic and Vijfvinkel). The modified flute needle. Top, Disassembled pieces. Bottom, The assembled needle.
Surface lavage of the eye is important after chemical injury as well as during ocular surgery in order to maintain corneal lubrication and clarity.1 Continuous ir rigation can also deliver topical medica tions to the cornea and conjunctiva. I have designed an irrigating eyelid speculum that can be attached to a sy-
550
AMERICAN JOURNAL OF OPHTHALMOLOGY
OCTOBER, 1983
BILATERAL GLAUCOMA CAUSED BY NASAL CARCINOMA OBSTRUCTING S C H L E M M ' S CANAL B R U C E L. J O H N S O N ,
M.D.
Eye Pathology Laboratory, Eye and Ear Hospital, 230 Lothrop St., Pittsburgh, PA 15213
Figure (Wilhelmus). Eyelid speculum with three irrigating portals on each retracting arm (arrows).
ringe or infusion bottle for continuous irrigation of the globe (Figure). Further modifications of the size, location, and direction of the irrigating portals can en hance its potential use in the operating room or emergency center. REFERENCE
1. Elsby, J. M.: Irrigating speculum. Br. J. Ophthalmol. 52:356, 1968.
Carcinoma metastatic to the eye has been recognized with increasing frequen cy in recent years. In almost all cases the predominant site of métastases is arterial embolization to the choroid. 1,2 In the larg est reported pathology series, only 26 of 227 patients (11%) with ocular métastases had the anterior segment as the predomi nant site. 3 My case demonstrated an un usual pattern of venous thrombosis by a nasal squamous carcinoma with glaucoma resulting from tumor obstruction of the canal of Schlemm and intrascleral and episcleral collector channels. A 74-year-old man with chronic lymphocytic leukemia was hospitalized be cause of maxillary facial pain. Radio graphs showed bilateral maxillary opacification suggesting maxillary sinusi tis. Examination of the nose disclosed large bilateral ulcerated and indurated areas of the septal mucosa. A biopsy specimen of the nasal septum disclosed an infiltrative, moderately well differen tiated squamous carcinoma. Radiation therapy was begun on an outpatient basis, but the patient was rehospitalized four weeks later with severe periorbital and nasal pain. An ophthalmic examination disclosed marked periorbital edema with conjunctival chemosis, injection, and scattered perivascular bulbar conjuncti val hemorrhages. Visual acuity was R.E.: 20/60 and L.E.: 20/80. The intraocular pressure was R.E.: 34 mm Hg and L.E.: 31 mm Hg. The anterior chamber angle was open bilaterally. Slit-lamp examina tion of the anterior segment showed only