This is a two part series on equipping your oculoplastic office. The last article, What You Need and How to Equip an Oculoplastic Surgery Office: Equipment, I discussed equipment that is necessary to outfit an oculoplastic office, including the basics of an eye lane down to furniture. This article, will focus on the tools that will complete the office.
Muscle Light
A muscle light is essential in every eye lane but particularly for oculoplastic disorders where a pupillary exam is essential. They can also be useful to transilluminate subcutaneous lesions.
Welch Allyn makes portable penlights that can be used to check the pupils and transilluminate in the clinic or bedside.
Indirect Ophthalmoscope
An indirect ophthalmoscope is necessary for the dilated fundoscopic examinations, especially to see way out into the periphery.
Keeler makes a variety of portable and wall mounted indirect ophthalmoscopes including wireless options that mount to your head or onto glasses. Iridex, Propper Manufacturing and Welch Allyn also make a variety of scopes.
Direct Ophthalmoscope
A direct ophthalmoscope should be available in the office to visualize the optic nerve in case you do not have your lenses to use with the slit lamp.
Keeler makes a pocket direct ophthalmoscope, as well as a variety of standard direct ophthalmoscopes. These scopes represent a hierarchy of lens ranges, the widest being +44D to -45D. An ophthalmoscope will similarly stand out in terms of light source, with the most sophisticated offering xenon gas illumination. Some offer lens filters optimized for specific applications such as red-free filters for the examination of blood vessels and blue filters for assessment of corneal scratches. Keeler also manufacture a Wide Angle Twin Mag Direct Ophthalmoscope. Welch Allyn also makes both pocket scopes and standard scopes.
Retinoscope
Although rarely used in most oculoplastic practices, a retinoscope is useful to detect refractive errors. Keeler makes an excellent bimodal retinoscope with either spot or streak beam with a quick bulb change. The Professional Combi Retinoscope is the only retinoscope that combines the ability to switch from spot to streak with the ability to double-check neutralization in both modes.
Exophthalmometer
Proptosis is fairly common in inflammatory conditions, infections and tumors of the orbit, and an exophthalmometer is what is needed to measure the degree. As well, we do see enophthalmos that needs to be measured.
The Hertel exophthalmometer is the most popular type of exophthalmometer. With the Hertel, the unit is held in both hands and held firmly against the left-hand orbital rim in line with the center of the cornea. Supports are placed against the temporal orbital walls, so the orbital rim contacts the deepest point of the supports. Hertel exophthalmometers are made by Oculus and Richmond Products.
The Naugle exophthalmometer rests on the superior and inferior orbital rims to avoid traumatic areas around the lateral canthus, increasing patient comfort and cooperation. Oculus and Richmond also make his instrument. Richmond Products also makes the Luedde exophthalmometer, the least expensive option. This instrument uses acrylic prisms at right angles to measure proptosis.
Applanation Tonometers
Most tonometers are attached to the slit lamp, but a handheld tonometer should be in every eye clinic in case the intraocular pressure is better measured without this large instrument. We all know how important an intraocular pressure measurement is in most exams.
Reichert offers the popular award winning handheld Tono-Pens:
Tono-Pen AVIA – easy to use and does not need daily calibration
Tono-Pen XL – the standard tonopen that most of us are familiar with
Vision Card
A vision card is handy as a portable tool to check vision bedside, for instance in post-operative patients. It is also used daily as a ruler in cases of ptosis measurements, for example.
Stereo Optical Company, Inc. makes glare-free laminated Teller Acuity Cards. These are digitally printed for increased accuracy and come with normative data included.
Color Vision Plates
This is a very useful test for optic nerve function. Since many oculoplastic disorders can affect the optic nerve, this is a necessary tool to have in such a practice.
The Ishihara Color Vision Test is most widely used. Plates/books are made by a variety of companies, including Keeler, Oculus, Precision Vision and Richmond Products. They come with 10, 14, 24 or 38 plates.
Loose Trial lenses
Not often used, but perhaps helpful when trying to quickly refract a patient, loose lenses can be obtained through Oculus.
Camera System
A camera is essential in an oculoplastic office, especially if time is spent on aesthetic treatments or research and publications. It is nice to have a standardized system with a chin rest and background, so exposure and tilt is the same each time.
Handheld Mirror
I have a handheld mirror in every lane and use it on almost every patient. It is especially useful when explaining a disease process and coming up with a treatment plan with your patient, especially if you are addressing aesthetic issues.
23-gauge cannula
These cannulas are important to have for evaluation of the tear drainage system in the case of potential nasolacrimal duct obstruction or canalicular stricture.
Storz manufactures cannulas in a variety of sizes, although I prefer the 23-gauge curved cannula.
Forceps
It is definitely useful to carry a variety of forceps in the clinic for small procedures that can be performed behind the slit lamp, such as epilation of misdirected lashes, suture removal and foreign body removal. I most commonly use jeweler’s forceps or 0.3 forceps, both manufactured by Storz. Epilation forceps are also useful.
Westcott Scissors
A helpful instrument to supplement the procedures mentioned in the paragraph above are the Westcott Scissors, manufactured and distributed by various companies including Storz. Also useful as an alternative are Steven’s Scissors or straight suture scissors.
Business Card Holders
Wall Mounts
Useful to hold brochures and magazines
Consumables
Below is a list of consumables commonly used in an oculoplastic practice.
- Cotton Tip Applicators
- Alcohol Swabs
- 4x4 gauze
- Tongue Blades
- Facial Tissues
- Exam Gloves
- Fluorescein Strips
- Rose Bengal Strips
- Schirmer Strips
- Proparacaine 0.5%
- Phenylephrine 2.5%
- Tropicamide 1%
- Steri-Strips
- Eye Patches
- Paper Tape
- Benzoin
- Irrigating Solution
- 3cc syringes
- Ocu-Film Tip Covers – for the tonopen
Hopefully this list will add to the article, What You Need and How to Equip an Oculoplastic Surgery Office: Equipment, to help anyone start an oculoplastic practice.