Corneal abrasion following anaesthesia for non-ocular surgical procedures: A case-controlled study

Ocular surface complications in children undergoing general anaesthesia: A prospective observational study

OBJECTIVE

Ophthalmic complications frequently occur after procedures requiring general anaesthesia, but their incidence is widely variable and not well reported in the paediatric population. The aim was to identify the incidence and possible risk factors of postoperative ocular surface complications in a tertiary care centre.

METHODS AND ANALYSIS

This is a prospective study for paediatric patients undergoing general anaesthesia. An ophthalmologist performed the ocular examination after surgery. Parameters assessed were tear breakup time, punctate epithelial erosions and corneal abrasions. Multivariate logistic regression model was used to assess risk factors.

RESULTS

A total of 108 paediatric patients were recruited, 36.1% showed abnormal corneal finding: 32 (29.6%) had decreased tear breakup time, three (2.7%) had punctate epithelial erosions, three (2.7%) had both punctate epithelial erosions and decreased tear breakup time and one (0.9%) was found to have a unilateral corneal abrasion postoperatively. A higher rate of corneal complications was noted with younger age, prolonged surgery and surgery in the head and neck region.

CONCLUSION

The rate of postoperative corneal abnormalities in children undergoing general anaesthesia was 36.1%, associated with younger age, prolonged surgery and surgery in the head and neck region.

Corneal injury after routine gastrointestinal endoscopy with moderate sedation

We report a case series of 4 patients who underwent routine gastrointestinal endoscopy under moderate sedation and developed corneal injuries. Although corneal abrasion has been reported as the most common ocular complication during non-ocular surgery under general anesthesia, the risk for corneal abrasion during routine endoscopic procedures using moderate sedation has not been previously reported. Symptoms reported included ocular burning, scratchy sensation, redness, and pain reported post-procedure. Endoscopists and staff should be alert to the occurrence of this potentially serious complication, as this is paramount for its prevention, diagnosis, and management. Treatment of corneal abrasion includes referral to ophthalmology for close monitoring, pain management, pressure patch, and antimicrobial prophylaxis.

Perioperative Corneal Abrasions After Nonocular Surgery: A Systematic Review

PURPOSE

To perform a systematic review of the international literature evaluating the risk factors, preventative steps, and treatments for perioperative corneal injuries for nonocular surgery.

METHODS

PubMed, Embase, and Evidence-Based Medicine Reviews databases were searched on April 13, 2018. Two hundred four articles were identified with 16 meeting the inclusion criteria. All studies were evaluated for quality and level of evidence. Two types of studies were included. The first were primary epidemiological studies that looked at the rates of perioperative corneal injuries after nonocular surgery and the second were trials that either studied preventative steps or treatments.

RESULTS

A statistical analysis was completed to reveal trends in perioperative corneal abrasions. Rates ranged from 0.01% to 59% with a cumulative rate of 0.64% (95% confidence interval 0.36%-1.35%). Primary risk factors were identified as longer procedures, general anesthesia, and advanced age. The most commonly associated ocular injuries were found to include chemical injury, conjunctivitis, blurred vision, and conjunctival congestion. Treatment strategies for corneal abrasion in the literature recommended erythromycin ointment and ample ocular lubrication for the fastest recovery. Education interventions alone, as studied in 2 of the 16 articles, demonstrated a significant decrease in the rate of corneal abrasions.

CONCLUSIONS

Standardized ocular protection, reporting, and education initiatives were found to maximally decrease rates of perioperative corneal abrasions after nonocular surgery. However, no gold standard currently exists for intraoperative ocular protection. More research needs to be conducted on specific prevention strategies and content of educational initiatives in hopes of standard development across facilities nationwide.

Effectiveness of corneal abrasion prevention interventions for adults undergoing general anesthesia for more than one hour: a systematic review protocol

REVIEW QUESTION

The question of this review is: what is the effectiveness of eye lubrication, tape and/or a combination of these interventions in preventing corneal abrasions in adult patients aged 18 and over undergoing general anesthesia for more than one hour?