Preoperative Care
Thorough preoperative preparation prevents surgical errors and ensures patient safety. The ophthalmic assistant plays a central role in many of these tasks.
Medical History Review
- Review current medications, especially blood thinners (aspirin, warfarin, clopidogrel). The surgeon and primary care physician determine whether to continue or temporarily stop these medications.
- Document allergies, particularly to anesthetics, antibiotics, iodine (used for antisepsis), and latex
- Confirm any required medical clearances are on file
- Verify the patient has followed preoperative instructions (fasting, drop instillation schedule)
Informed Consent
Informed consent is a legal and ethical requirement. The surgeon must explain the procedure, its risks, benefits, alternatives, and expected outcomes. The patient must demonstrate understanding and voluntarily agree. The assistant ensures the consent form is properly signed and witnessed before the procedure begins.
Site Marking and Time-Out
Site marking identifies the correct operative eye. A mark (typically the surgeon's initials or a checkmark) is placed above or beside the operative eye while the patient is awake and can confirm. This prevents wrong-eye surgery, one of the most devastating preventable errors.
The time-out (also called a surgical pause) is performed immediately before the procedure begins. The entire team pauses to verbally confirm:
- Correct patient identity
- Correct procedure
- Correct operative eye
- Correct IOL (if applicable)
- Any relevant allergies or special considerations
Postoperative Care
Post-Op Instructions
Clear, written postoperative instructions should cover:
- Drop schedule: Which drops, how many times daily, and for how long
- Activity restrictions: Avoid heavy lifting, bending, rubbing the eye, swimming
- Eye protection: Wear the provided shield, especially while sleeping
- Follow-up appointments: Typically day 1, week 1, and week 4-6 post-surgery
Warning Signs
Patients must know which symptoms require immediate contact with the office:
- Sudden decrease in vision
- Increasing pain not relieved by over-the-counter medication
- Increasing redness
- New flashes or floaters
- Purulent discharge
These may indicate endophthalmitis, retinal detachment, elevated IOP, or wound leak, all of which require urgent evaluation.
Key Takeaways
- Preoperative preparation includes medical history review, informed consent, site marking, and the time-out procedure
- Blood thinner management requires coordination between the surgeon and the patient's primary care physician
- The time-out is a mandatory safety checkpoint performed before every procedure
- Postoperative instructions must be clear, written, and include emergency warning signs
- Patients should understand and be able to repeat back key postoperative instructions