Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery

Abstract

The authors reviewed perioperative ocular complications and implications of ocular diseases during nonocular surgeries. Exposure keratopathy, the most common perioperative eye injury, is preventable. Ischemic optic neuropathy, the leading cause of perioperative blindness, has well-defined risk factors. The incidence of ischemic optic neuropathy after spine fusion, but not cardiac surgery, has been decreasing. Central retinal artery occlusion during spine fusion surgery can be prevented by protecting eyes from compression. Perioperative acute angle closure glaucoma is a vision-threatening emergency that can be successfully treated by rapid reduction of elevated intraocular pressure. Differential diagnoses of visual dysfunction in the perioperative period and treatments are detailed. Although glaucoma is increasingly prevalent and often questions arise concerning perioperative anesthetic management, evidence-based recommendations to guide safe anesthesia care in patients with glaucoma are currently lacking. Patients with low vision present challenges to the anesthesia provider that are becoming more common as the population ages.

Evaluating the Effects of a General Anesthesia and Prone Position Nursing Checklist and Training Course on Posterior Lumbar Surgery: A Randomized Controlled Trial

“…These measures can avoid injury due to ocular compression, eye exposure, and excessive abduction of the upper limbs. 22,28 During surgery, all items from the "after prone positioning" stage should be rechecked after the patient is repositioned or the procedure bed or equipment attached to the bed is moved. The circulating nurse must constantly adjust the angle of the OR bed to provide the best surgical field for the procedure.…”

“…Immediately after prone positioning, the table headrest should be examined for appropriate use, the patient’s eyes should be closed and uncompressed, and the patient’s arms should be placed on padded boards abducted to less than 90 degrees or at the side of the body with the elbows flexed and the palms facing downward. These measures can avoid injury due to ocular compression, eye exposure, and excessive abduction of the upper limbs 22,28 . During surgery, all items from the “after prone positioning” stage should be rechecked after the patient is repositioned or the procedure bed or equipment attached to the bed is moved.…”

Anesthesia and Eye Diseases: Comment

“…The review by Roth et al 1 addresses an important issue. The authors state that complete closure of eyelids “soon” after induction of general anesthesia and “preferably” before airway management is a key component of prevention of perioperative exposure keratopathy.…”

Anesthesia and Eye Diseases: Reply

“…

our review article in Anesthesiology. 2 They have provided a valuable caveat to what we wrote with respect to prevention of corneal abrasions. Dr. Priebe 1 is correct that the eyes should be properly covered immediately after loss of the eyelid reflex after induction of anesthesia.

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