Corneal Abrasion following Anaesthesia for Non-ocular Surgical Procedures: A Case-controlled Study

Abstract

The aim of this study was to identify risk factors associated with perioperative corneal abrasion at a single hospital in Mineola, New York (United States). A chart review was conducted of patients with perioperative corneal abrasion following non-ocular surgery and age-matched controls between June 2011 and November 2013. An age-stratified logistic regression model evaluated the association between corneal abrasion and potentially predisposing variables. The adjusted odds of a corneal abrasion occurring were 4.6 times greater for patients having surgery for ≥ 3 hours (p=0.001) and 3.6 times greater for patients with pre-existing ocular disease (p=0.02). Gender, diabetes status, surgical procedure or position were not found to be associated with the occurrence of a corneal abrasion. Corneal abrasions were associated with longer procedures and history of pre-existing ocular disease. No significant association between body positioning or surgical site and perioperative corneal abrasion was found. The study concludes that a longer duration of surgical procedure and pre-existing ocular disease are risk factors for perioperative corneal abrasion.

An Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injury

“…The latter study, conducted at New York University, did not find a significant difference. 13 In contrast, our study identified a significantly higher rate of perioperative corneal injury associated with vascular surgery compared with other surgical services. Although the vascular surgery group had a significantly higher proportion of patients with such previously identified risk factors for corneal injury such as supine position and longer surgical time, vascular surgery had an independently significant effect on corneal injury risk even after adjustment for the previously identified risk factors.…”

“…1,3 Additional reported risk factors for perioperative corneal injury include prone and lateral positioning, head and neck surgery, prolonged surgery (> 90 minutes), early practitioner training level, presence of diabetes mellitus or thyroid disease, intraoperative sustained hypotension, and anemia. [7][8][9][10][11][12][13][14] A computerized search of the PubMed database reveals four academic institutions that have published in the anesthesia literature the incidence of perioperative corneal injury at their sites. The incidence of perioperative corneal injury was reported to be 0.15% in 2005 and 0.33% between 2011 and 2017 at the Mayo Clinic (of note, the reporting strategy differed between the two studies), 1,14 0.034% between 1988 and 1992 at the University of Chicago, 15 0.12% in 2012 at the University of Alabama (UAB), 16 and 0.07% between 2011 and 2013 at New York University.…”

“…The incidence of perioperative corneal injury was reported to be 0.15% in 2005 and 0.33% between 2011 and 2017 at the Mayo Clinic (of note, the reporting strategy differed between the two studies), 1,14 0.034% between 1988 and 1992 at the University of Chicago, 15 0.12% in 2012 at the University of Alabama (UAB), 16 and 0.07% between 2011 and 2013 at New York University. 13 The Mayo Clinic and UAB anesthesia departments each performed a quality improvement (QI) corneal abrasion prevention program; incidence of perioperative corneal injury decreased from 0.15 to 0.047% at Mayo and from 0.12 to 0.009% at UAB. 16 No such reports exist in the ophthalmology literature, with primarily anesthesiologists taking the lead to develop their own corneal injury prevention and management plans.…”

Corneal injury after routine gastrointestinal endoscopy with moderate sedation

“…Perioperative corneal abrasions under general anesthesia may be attributed to direct chemical or mechanical trauma to the cornea, or to exposure and drying due to lagophthalmos (incomplete eyelid closure) [3-5]. Additional risk factors include lateral or prone positioning, advanced patient age, longer procedure times (especially those > 1 h), supplemental oxygen en route to or in the post-anesthesia care unit, and trauma due to direct contact with the cornea [1-3,5,6]. A single case of this complication associated with endoscopy was reported 24 years ago, in a 75-year-old male undergoing advanced endoscopy (endoscopic retrograde cholangiopancreatogram) in the prone position under moderate sedation.…”

A Quality Improvement Project to Decrease Perioperative and Periprocedural Corneal Abrasions

“…6 Published studies have shown that standardization of prevention measures is important for reducing the perioperative incidence of CA. 5,[7][8][9] The aims of our study were to determine the baseline incidence rate of CA in our practice, to implement best practice prevention and management of CA, and to determine whether the change in our standard of care resulted in a sustained decrease in incidence of perioperative and periprocedural CA.…”