Evaluation and Treatment of Perioperative Corneal Abrasions

Abstract

Purpose. To evaluate perioperative risk factors for corneal abrasion (CA) and to determine current care for perioperative CA in a tertiary care setting. Methods. Hospital-based, cross-sectional study. In Operating Room and Post-Anesthesia Care Units patients, a comparison of cases and controls was evaluated to elucidate risk factors, time to treatment, and most common treatments prescribed for corneal abrasions. Results. 86 cases of corneal abrasion and 89 controls were identified from the 78,542 surgical procedures performed over 2 years. Statistically significant risk factors were age (P = 0.0037), general anesthesia (P < 0.001), greater average estimated blood loss (P < 0.001), eyes taped during surgery (P < 0.001), prone position (P < 0.001), trendelenburg position (P < 0.001), and supplemental oxygen en route to and in the Post-Anesthesia Care Units (P < 0.001). Average time to complaint was 129 minutes. 94% of cases had an inpatient ophthalmology consult, with an average time to consult of 164 minutes. The most common treatment was artificial tears alone (40%), followed by combination treatment of antibiotic ointment and artificial tears (35.3%). Conclusions. Trendelenburg positioning is a novel risk factor for CA. Diagnosis and treatment of perioperative corneal abrasions by an ophthalmologist typically require three hours in the tertiary care setting.

Epidemiologic Evaluation and Clinical Aspects of Superficial Corneal Foreign Body Injuries at a Tertiary Referral Center in İstanbul

“…Studies did not suggest a routine eye patch for corneal abrasions, because it does not have any effect on healing time and pain (10). It has also been indicated that smaller abrasions, as in CFB trauma, could be treated only with antibiotic ointments (11). Following CFB removal, all patients in the current study were prescribed ocular antibiotic drops without eye patching, and then patients were re-assessed two days after the procedure.…”

Perioperative Corneal Abrasion: Updated Guidelines for Prevention and Management

“…Segal et al 6 found oxygen use during transport and recovery to be a significant risk factor, supporting the idea that face masks are a preventable cause of abrasions. Eye shields are commonly used during periorbital surgery to protect the eye from direct trauma; however, these must be inspected for surface irregularities before each case and require careful placement/removal, as they have been known to cause corneal injury.…”

“…3,6,15 Longer anesthesia times lengthen the period of diminished protective mechanisms. Furthermore, tear production 16 and breakup time 4 are reduced to an even greater extent with increasing duration of general anesthesia.…”

“…Procedures requiring lateral, prone, and Trendelenburg positions have a higher incidence of corneal abrasion. [3][4][5][6]17 In lateral and prone positions, the head is turned to the side or face-down, with one or both eyes placed in a dependent position. Because of gravity, the dependent globe is prone to exposure.…”

The need for eye protection during general anaesthesia and the efficacy of various eye protection methods

“…Published data report an incidence range of 0.17%-44%. 7 Roth S et al studied-on eye injuries during anaesthesia in a huge number of patients and concluded that lengthier the procedures more the eye injuries. 2 Most corneal abrasions are not due to trauma alone but instead due to drying of corneal epithelium probably due to the decreased basal tear production.…”