treatment plan

A Holiday Wish List for Your Practice

BY WILLIAM TOWNSEND, OD
DECEMBER 1998

At the end of the year, it makes sense to restock your instrument supply to make 1999 a better year for your practice. The tools you compile can be new or simply rediscovered.

Calcium Alginate Swabs

There are several advantages to using calcium alginate swabs. First and perhaps most importantly, it is a kinder and gentler means of debriding tissue than using a spatula. Just moisten the swab with a few drops of sterile artificial tears or saline, then gently use the tip of the swab to remove the damaged tissue. They are also inexpensive, disposable and don't require flaming or sterilization. They don't leave fibers like their cotton-tipped cousins do, and because they're absorbent, these swabs are also useful for applications where a liquid substance must be removed from the ocular surface.

Forceps: the More the Merrier

For most anterior segment procedures, you'll need one of three types of forceps. Straight forceps are useful in removing foreign bodies, holding sutures and modifying needles. Curved-tip or angled-tip forceps are used for inserting punctal plugs, grasping cysts you're opening and for approaching hard-to-reach foreign bodies from a difficult angle. Cilia forceps are specifically designed for epilation. Rather than cutting the lash, they give the doctor enough grip to remove it from the follicle.

Until recently, all forceps used in eye care were stainless steel, which can rust under certain conditions. Now forceps and other ophthalmic instruments are available in titanium, a lightweight, space-age metal that doesn't rust.

When handling or sterilizing forceps, be careful not to drop or bump the tip of the instrument. Once bent, these fine-tipped tools are no longer very useful, and they're fairly expensive. One other tip -- buy two of each type of forceps so you're prepared for multiple emergencies. They're a worthwhile investment.

Bent-Tip Needles

Anterior stromal micropuncture (ASM) has shown to be useful in the management of recalcitrant corneal erosions. In the past, doctors who performed this procedure used sterile forceps to bend their needles with approximately 0.15mm of tip angled away from the bevel. The purpose of the bend is to prevent inadvertent perforation of the cornea. Surgical Specialty Corp. (formerly Look, Inc.), Chicago, manufactures a pre-bent needle for ASM.

Lid Specula

Most patients undergoing anterior segment procedures cooperate by keeping their lids open. A small but regrettably memorable group can't. I've found that in performing primary care procedures on these patients, a lid speculum is indispensable. Several styles are available, but my favorite is the Barraquer speculum. It's easy to insert and remove, simple in design, easy to sterilize and very reasonably priced.

We also use this device when we need to examine a child's fundus and examination under anesthesia is not an option. Once the speculum is in place, children seem to sense that further struggle is pointless, and they allow us to proceed with the examination. As with all other instruments used in and around ocular tissue, we recommend sterilizing the speculum rather than disinfecting it. One note of caution -- never use a speculum if you suspect a penetrating foreign body or globe laceration.

Add these tools to your holiday wish list for you and your practice. Having these useful devices at hand will make 1999 a successful year for you and your patients. Happy holidays, and God bless you and your families in this joyous season.

Dr. Townsend is in private practice in Canyon, Texas, and is a consultant at the Amarillo VA Medical Center.