Corneal Injuries During General Anesthesia

Abstract

A corneal abrasion is the most common eye complication during general anesthesia and recovery. It is painful, may progress to inflammation of the uveal tract, and in the presence of contamination may lead to a serious infection. Both eyes may be involved, as the two reported cases show. Possible causes include mask friction on the open eye or other careless technics. Treatment includes local application of an antibiotic ointment and an eye pressure patch. In addition, a cycloplegic and mydriatic solution is instilled to prevent synechiae (in the presence of a secondary iridocyclitis) and to relieve the pain associated with spasm of the iris and ciliary muscle. Topical application of local anesthetics should be avoided, as they delay regeneration of corneal epithelium and may promote keratitis.

Protection of the Eyes With Ophthalmic Ointments During General Anaesthesia

“…Only a few have used ophthalmological assistance or tried to evaluate the injury to the cornea (Snow et al 1975).…”

Detection and Treatment of Perioperative Corneal Abrasions

“…12 Patients with ocular conditions that increase prominence of the eye globe such as proptosis or exophthalmos may be at increased risk for inadvertent corneal exposure. 15 A second mechanism of injury is related to the avascular nature of the cornea. Pressure applied to the globe of the eye can reduce choroidal blood flow, decreasing blood flow to the peripheral cornea.…”

“…Direct chemical trauma to the cornea can occur from accidental spillage of sterilizing chemicals during surgical preparation. 12,15 Chemical trauma may also be related to the irritating properties of inhaled anesthetics 11,12 and the application of preservative-containing eye ointments. 17 Direct mechanical trauma may occur as a result of direct contact with the cornea from the anesthesia facemask, activities associated with laryngoscopy, surgical drapes, surgical instrumentation, and other activities in which direct contact with the cornea may occur.…”

“…17 Direct mechanical trauma may occur as a result of direct contact with the cornea from the anesthesia facemask, activities associated with laryngoscopy, surgical drapes, surgical instrumentation, and other activities in which direct contact with the cornea may occur. 4 Direct mechanical trauma to the cornea may occur in the immediate postoperative period as a result of eye contact with an oxygen face mask, nasal cannula, rubbing of the eyes with or without a pulse oximetry probe, 1 restless activity, 15 and recovering in the lateral position. 9…”

Airway Management of the Nonintubated Patient

“…Pressure by the mask on the eyeball may result in ischemic injury to the retina and optic nerve [1]. Corneal abrasions may result if the eyes are not kept closed [2,3]. Pressure from the rescuer's hand, the mask, or head straps may also result in injury to the supraorbital, infraorbital, or mental nerves [4,5,6].…”