Users Online: 19 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 
 

 
Table of Contents
LETTER TO EDITOR
Year : 2013  |  Volume : 29  |  Issue : 1  |  Page : 138-139

Perioperative eye protection under general anesthesia


Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India

Date of Web Publication10-Jan-2013

Correspondence Address:
Smita Prakash
C17 HUDCO Place, New Delhi - 110 049
India
Login to access the Email id


DOI: 10.4103/0970-9185.105834

PMID: 23495279

Get Permissions


How to cite this article:
Prakash S. Perioperative eye protection under general anesthesia. J Anaesthesiol Clin Pharmacol 2013;29:138-9

How to cite this URL:
Prakash S. Perioperative eye protection under general anesthesia. J Anaesthesiol Clin Pharmacol [serial online] 2013 [cited 2014 Dec 22];29:138-9. Available from: http://www.joacp.org/text.asp?2013/29/1/138/105834

Sir,

I read with interest the article "Comprehensive eye care: A simple step toward a better outcome" by Hariharan. [1] Patients undergoing prolonged non-ocular surgery under general anesthesia may develop ophthalmic complications. Corneal abrasion is the commonest injury with an incidence of 44% in unprotected eyes. [2],[3] Abolition of the protective corneal reflex, decreased basal tear production, and absence of pain perception are the causative contributory factors. [2]

During general anesthesia, eyes need protection either by tape or ointment to avoid corneal injuries. [4] Several approaches have been used to ensure that the eyelids remain closed, such as passive closure, hypoallergenic tape, eye patches, saline-soaked pads, and suturing. Cucchiara and Black [5] also suggest taping the eye immediately after induction of anesthesia and leaving the eyes taped till the end of the procedure and considered the use of ointment optional.

For surgeries on the face such as cleft lip, we use transparent film dressing (Tegaderm™, 3M, Bangalore, India) to protect the eyes from cleaning solutions. It is transparent, waterproof, and has a hypoallergenic adhesive that gently adheres to the skin and provides a barrier to external contaminants. For ease of application, we cut the film into two horizontal halves and place the cut halves on each eye with the cut portion on the cheeks before removing the frame of the film.

Ocular lubricants should be placed in the conjunctival sac. Overenthusiastic or incorrect application of the ointment on the eyelashes may lead to inadvertent depilation when the ointment has dried. Another cause is taping the eyes shut by sticking tape which can adhere to the eyelashes and result in depilation on removal of the tape. The sticking tape should be placed on the skin overlying the tarsal plate. Placement of padding over the closed eyes is useful. It is common practice to use an antibiotic ointment in lieu of artificial tear gel or ocular lubricant. Availability and use of lubricating methylcellulose eye gel drops should be encouraged.

There are mixed reports in the literature regarding recommendation for use of gel, ointment, or eye drops to moisten eyes during anesthesia. While Schmidt and Boggild-Madsen [6] reported no difference between methylcellulose and paraffin-based ointment, others found methylcellulose 4% to provide better eye protection. [2] Manecke et al. [7] reported a high incidence of eyelid edema, conjunctival hyperemia, and blurred vision in the paraffin (lipid-based) eye lubricant when compared with a methylcellulose (water-based) eye lubricant and postulated that the inhalational anesthetic was concentrated in the lipid-based paraffin and irritating the eye. Kocatürk et al. [4] found hypoallergenic adhesive tape, antibiotic ointment, artificial tear liquid gel, and ocular lubricant to be equally efficacious for perioperative eye protection under anesthesia in the prone position. White and Crosse [8] do not recommend the routine instillation of aqueous solutions, viscous gels, or ointments, because they do not offer sufficient additional protection against development of corneal abrasions, and ointments in particular contributed to significant ocular morbidity.

Eye damage under anesthesia is a preventable complication. Emphasis on correct training of the concerned caregivers with regard to eye protection methods will go a long way in decreasing serious ocular morbidity under general anesthesia.

 
  References Top

1.Hariharan U. Comprehensive eye care: A simple step toward a better outcome. J Anaesthesiol Clin Pharmacol 2012;28:279.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Boggild-Madsen NB, Bundgarrd-Nielsen P, Hammer U, Jacobsen B. Comparison of eye protection with methylcellulose and paraffin ointments during general anesthesia. Can Anaesth Soc J 1981;28:575-8.  Back to cited text no. 2
    
3.Batra YK, Bali IM. Corneal abrasions during general anesthesia. Anesth Analg 1977;56:363-5.  Back to cited text no. 3
[PUBMED]    
4.Kocatürk O, Kocatürk T, Kaan N, Dayanir V. The comparison of four different methods of perioperative eye protection under general anesthesia in prone position. J Clin Anal Med 2012;3:163-5.  Back to cited text no. 4
    
5.Cucchiara RF, Black S. Corneal abrasion during anesthesia and surgery. Anesthesiology 1988;69:978-9.  Back to cited text no. 5
    
6.Schmidt P, Boggild-Madsen NB. Protection of the eyes with ophthalmic ointments during general anesthesia. Acta Ophthalmol 1981;59:422-7.  Back to cited text no. 6
    
7.Manecke GR Jr, Tannenbaum DP, McCoy BE. Severe bilateral corneal injury attributed to a preservative-containing eye lubricant. Anesthesiology 2000;93:1545-6.  Back to cited text no. 7
    
8.White E, Crosse MM. The aetiology and prevention of peri-operative corneal abrasions. Anaesthesia 1998;53:157-61.  Back to cited text no. 8
    



This article has been cited by
1 A simple technique for temporary eyelid closure in severe exposure keratopathy
Göran Darius Hildebrand,Sally L. Painter
Journal of American Association for Pediatric Ophthalmology and Strabismus. 2014;
[Pubmed]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed1822    
    Printed40    
    Emailed1    
    PDF Downloaded315    
    Comments [Add]    
    Cited by others 1    

Recommend this journal