Clinic Name
Clinic Address
Clinic Phone Number
Clinic Email
SUPPLIES:
- 1 Basic Pack
- 1 Split Sheet
- 1 Mayo Cover
- 1 Raytec
- 1 Specimen Cup
- 1 Bovie Pencil
- 1 Bovie Pad
- 1 Yankeur (HOLD)
- 1 Pack Sterile Towels
- 1 Suction Tubing
- 1 Bed Cover
- 3 Gowns
- 2 Gloves (8)
- 2 Gloves Scrub
- 1 Pack 4x4 Gauze
- 2 Packs Q-Tips
- 1 B SS
- 1 Blue Pad
- 6 Carpules
- 1 Syringe 60cc
- 1 Syringe 10cc (.25% Marc w/ Epi)
- 1 Jelco (pink)
- 1 Dental Needle 30g
- 1 Needle 30g
- 1 Utah Tip
- 2 Donuts
PREP:
- Clear Eye Shields
- Squeegee
- Dental Syringe
- Gloves (8)
- 4x4
- Specimen Cup
- Carpules (6)
- Small Bowl
- Demars Eyelid Retractor
MAYO:
- Deans
- Browns (2)
- Iris
- Stat
- Small Needle Driver
- Frazier Tip
- Jaegar Retractor
- Lid Retractor
SUTURE:
- 1 Plain Gut 6-0 G-1
DRESSINGS:
- BSS Ophthalmic Ointment
- Ice pack
INSTRUMENTS:
- Plastic Set
- Mag. Pad
- Light Handle
- Large Bowl
IF PTOSIS REPAIR (add the following):
- 1 Vicryl 4-0 P-3
- 1 Plain Gut 6-0 G-1
IF CANTHOPEXY ( add the following ):
Supplies:
- 1 Blade #15
Suture:
- 1-Prolene 4-0 P3
- 1-Plain Gut 6-0 G
Mayo:
- 2 Elevators #9
Instruments:
- Stryker Drill
- Canthopexy Drill Bit
NOTES:
- Upper and lower bleph does lower bleph first, so put clear eye shields on prep tray, and metal ones on mayo tray.