Simini Boards Cast
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Simini Boards Cast
Chapter 124 - Part E: When the Eye Cannot Be Saved
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In this BoardsCast episode, we finish Tobias Chapter 124 — Basic Ophthalmic Surgical Procedures with the hardest (and highest-level) decision in ophthalmic surgery:
When do you stop saving the globe… and start saving the patient from the globe?
This episode builds a clear, board-ready decision framework for end-stage eyes that are blind, painful, and failing—where continued “salvage” is no longer medicine, it’s prolonged suffering.
You’ll learn:
- The 3-question hierarchy Tobias emphasizes: Is vision recoverable? Is comfort recoverable? Is the globe structurally salvageable?
- Why end-stage glaucoma is the classic trap: aqueous production continues, outflow fails, pressure rises, and pain becomes relentless
- The salvage surgery toolbox—and when each is appropriate:
- Enucleation (remove globe)
- Evisceration + prosthesis (remove contents, keep scleral shell—strictly selected cases)
- Exenteration (oncologic removal of globe + orbital contents)
- The hidden surgical risk that boards love: excess traction on the globe can injure the optic chiasm and blind the contralateral eye
- Post-op welfare rules that matter more than ego: safe analgesia choices and the E-collar as a non-negotiable
Key takeaway: Quality of life beats anatomy. The goal was never the globe. The goal was the patient.
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