Examination under general anthesia

1. DR. ALSHYMAA MOUSTAFA
OPHTHALMOLOGIST

2. Review
• Goals
• Equipments
• Steps

3. INTRODUCTION

4. Goals
1. Diagnose
2. Properly classify the type of glaucoma
3. Identify any primary aetiologies
4. Set a baseline for future comparison
5. Document findings necessary to develop a
treatment plan
6. Monitor the effects of treatment

5. • The whole child should be examined for signs
1. Orbital changes
2. Skin (neurofibromatosis, Sturge-Weber)
3. Other organ involvement indicating disease
associated with the glaucoma.

6. Anathesia IOP
• General anesthetics are known to have a potent effect
on IOP on both normal and glaucomatous eyes.
• Virtually all of the inhalational anesthetics are known
to depress the IOP within minutes of administration.
• Ketamine HCl slowly elevates the IOP as deeper
anesthesia is attained.
• The benzodiazepines do not appear to have a
significant effect on IOP when used in preoperative
doses.

7. So , what will happen..?
• Midazolam HCl (Versed) is often used as a
preoperative sedative in children, and in many
cases the child is sufficiently sedated with this
medication to perform quick IOP measurement
before the administration of an inhalational general
anesthetic.
• Such a measurement, with the child resting
comfortably but not under the influence of the
potent inhalational anesthetics, is probably the
most accurate.

8. Highly agitated ...... 🤔
• The anesthesiologist should be aware that it is
preferable for the surgeon to measure the IOP as
early as possible during the induction of general
anesthesia.

9. Equipment for EUA

10. • Not of all these pieces of equipment are absolutely
necessary but each instrument does add to the
quality of examination.
• In short, do the best you can with what you have.

11. 1_ Calipers or ruler (ruler can also be used to check
accuracy of the caliper scale)
2_ Direct ophthalmoscope

12. 3_ Indirect ophthalmoscope with 20D condensing
lens
4_ Retinoscope and loose refracting lenses or bars

13. 5_ Goniolens for examination of the angle and
perhaps the fundus - if it is a direct-viewing model,
with fluid for lens-cornea contact
6_ Pachymeter (not essential but very useful)

14. 7_ Eyelid speculum (handy, but not essential)
8_ Hand-held slit lamp or operating microscope
9_ Tonometer (Schiotz, Perkins, TONO-PEN or other
applanation device)

15. Seven Steps

16. Step 1: Cornea and Anterior Segment
Step 2: Intraocular Pressure
Step 3: Posterior Segment
Step 4: Gonioscopy
Step 5: Supplemental Examination
Step 6: Diagnostic Paradigm
Step 7: EUA Summary