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DIFFICULT DOCKING
The following are 5 main factors that may coexist and result in difficult docking: small palpebral fissure (Figure 14-1), lid squeezing, conjunctival chalasis (Figure 14-2), deep orbit, and particular nose shape.
Small Palpebral Fissure
In patients with narrow palpebral fissures, space is limited. Turning an individual’s head away from the eye that is having surgery causes the eyeball to rotate away from the nose, and creates extra space to place the suction ring. A lid speculum may be used to give better exposure to get the vacuum ring onto the globe.
Lid Squeezing
This may exert pressure on the suction ring, and lead to loss of suction. Prompting the patient to relax and adding an anesthetic drop may help. Furthermore, putting an anesthetic in the fellow eye and asking the patient to keep that eye open can assist in keeping the surgical eye open. Using a lid speculum may improve exposure to get the vacuum ring into the eye and counteract lid squeezing.
Figure 14-1. Docking with a small palpebral fissure.
Figure 14-2. Photograph showing conjunctival chalasis and lid squeezing during a docking attempt.
Conjunctival Chalasis
Sometimes, patients have loose redundant conjunctiva. In these cases, the conjunctiva closes the suction port rather than the eyeball itself, giving pseudosuction. Pushing the lid speculum down (if used during docking) or pushing the conjunctiva away with a suction ring (prior to suction initiation) may help to initiate suction.
Figure 14-3. Relationship between the tracking system and the headrest.
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