The aetiology and prevention of peri‐operative corneal abrasions

Abstract

SummaryCorneal abrasion is the most frequent ocular complication to occur during the peri-operative period. This review describes the aetiology of corneal abrasions and evaluates the current methods of prevention. Most abrasions are caused by lagophthalmos (failure of the eyelids to close fully) during general anaesthesia, resulting in corneal drying. General anaesthesia reduces both the production and the stability of tears and therefore increases the incidence of this painful condition. Taping the eyelids closed, soft contact lenses, the instillation of aqueous gels or paraffin-based ointments are all effective in preventing corneal abrasions, but ointments are associated with significant morbidity.

Pain, nausea, vomiting and ocular complications delay discharge following ambulatory microdiscectomy

“…26,27 Failure of the eyelids to close fully during general anesthesia may lead to corneal drying and corneal abrasion. 28 General anesthesia reduces both the production and the stability of tears and therefore increases the incidence of dry eyes. 28,29 The application of ointment and adhesive tape to the eyes may limit this complication.…”

“…28 General anesthesia reduces both the production and the stability of tears and therefore increases the incidence of dry eyes. 28,29 The application of ointment and adhesive tape to the eyes may limit this complication. Cautious positioning of the patient in the prone position to avoid pressure on the eyes may further improve the outcome.…”

The Comparison of Four Different Methods of Perioperative Eye Protection under General Anesthesia in Prone Position

“…White and Crosse [11] has not recommended the routine instillation of aqueous solutions, viscous gels or ointments, because they did not offer sufficient additional protection against the development of corneal abrasions, and ointments in particular contributed to significant ocular morbidity. [11] Manecke et al [12] showed a high incidence of eyelid edema, conjunctival hyperaemia and blurred vision in the paraffin (lipid-based) eye lubricant when compared with a methylcellulose solution (water-based) eye lubricants and postulated that the inhalational anaesthetic (halothane) was concentrated in the lipid-based paraffin and irritating to the eye. Boggild-Madsen and colleagues [1] reported that during general anaesthesia methylcellulose 4% provides better eye protection than paraffin-based ointment.…”

Clear hydro-gel, compared to ointment, provides improved eye comfort after brief surgery

“…Among the strategies used in perioperative care, simple manual closure of the eyelids, taping the eyelids closed, and the instillation of protective substances into the conjunctival sac are most commonly employed. 4 Substances in frequent use today include hydrogels and ointments. However, bacteriostatic properties, patient comfort, and ability of the anesthesiologist to assess pupillary dilation have been described as different for these two groups of substances.…”

“…However, bacteriostatic properties, patient comfort, and ability of the anesthesiologist to assess pupillary dilation have been described as different for these two groups of substances. 4,5 It was the objective of the present study to compare a transparent clear ocular hydro-gel (Vidisic®, Mann Pharma, Berlin, Germany) and a commonly used dexpanthenol and vitamin A based ointment (Oleovit®, Fresenius Kabi, Linz, Austria) as examples of these classes of ocular lubricants, in their capability to (a) ensure perioperative ocular comfort; and to (b) impair bacterial growth in vitro.…”