Evaluation and treatment of perioperative corneal abrasions

Kira L Segal, Peter M Fleischut, Charles Kim, Ben Levine, Susan L Faggiani, Samprit Banerjee, Farida Gadalla, Gary J Lelli Jr, Kira L Segal, Peter M Fleischut, Charles Kim, Ben Levine, Susan L Faggiani, Samprit Banerjee, Farida Gadalla, Gary J Lelli Jr

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.

Figures

Figure 1
Figure 1
Corneal abrasion treatment algorithm.

References

    1. Snow JC, Kripke BJ, Norton ML, Chandra P, Woodcome HA. Corneal injuries during general anesthesia. Anesthesia and Analgesia. 1975;54(4):465–467.
    1. Batra YK, Bali IM. Corneal abrasions during general anesthesia. Anesthesia and Analgesia. 1977;56(3):363–365.
    1. Cucchiara RF, Black S. Corneal abrasion during anesthesia and surgery. Anesthesiology. 1988;69(6):978–979.
    1. White E, Crosse MM. The aetiology and prevention of peri-operative corneal abrasions. Anaesthesia. 1998;53(2):157–161.
    1. Roth S, Thisted RA, Erickson JP, Black S, Schreider BD. Eye injuries after nonocular surgery: a study of 60,965 anesthetics from 1988 to 1992. Anesthesiology. 1996;85(5):1020–1027.
    1. Terry TH, Kearns TP, Grafton-Loue J, Orwell G. Untoward ophthalmic and neurological events of anesthesia. Surgical Clinics of North America. 1965;45:927–929.
    1. Duncalf D, Rhodes DH. Anesthesia in Clinical Ophthalmology. Baltimore, Md, USA: The Williams & Wilkins; 1963.
    1. Jampol LM, Neufeld AH, Sears M. Pathways for the response of the eye to injury. Investigative Ophthalmology. 1975;14(3):184–189.
    1. Martin DP, Weingarten TN, Gunn PW, et al. Performance improvement system and postoperative corneal injuries: incidence and risk factors. Anesthesiology. 2009;111(2):320–326.
    1. Gild WM, Posner KL, Caplan RA, Cheney FW. Eye injuries associated with anesthesia: a closed claims analysis. Anesthesiology. 1992;76(2):204–208.
    1. Murray WJ, Ruddy MP. Toxic eye injury during induction of anesthesia. Southern Medical Journal. 1985;78(8):1012–1013.
    1. Stein RM, Cohen EJ, Lugo M. Corneal ulcer resulting from dental instrument injury. American Journal of Ophthalmology. 1987;103:333–334.
    1. Grant GP, Szirth BC, Bennett HL, et al. Effects of prone and reverse trendelenburg positioning on ocular parameters. Anesthesiology. 2010;112(1):57–65.
    1. Stambough JL, Dolan D, Werner R, Godfrey E. Ophthalmologic complications associated with prone positioning in spine surgery. Journal of the American Academy of Orthopaedic Surgeons. 2007;15(3):156–165.
    1. Green S, Goodwin H, Moss J. Risk Management in Anesthesia. London, UK: The Medical Defense Union; 1997.
    1. Fraser S. Corneal abrasion. Clinical Ophthalmology. 2010;4:387–390.
    1. Turner A, Rabiu M. Patching for corneal abrasion. Cochrane Database of Systematic Reviews. 2006;(2)CD004764

Source: PubMed

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