Postoperative eye injuries

[Planktonmd]

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So....
I know all of you deal with ocular pain or injury after GA...
Typical presentation:
Patient wakes up after GA and complains of severe burning in one or both eyes...
You are called to deal with it...
Let's discuss why it happens... how to prevent it... and how to treat it

 

[norwood]

So....
I know all of you deal with ocular pain or injury after GA...
Typical presentation:
Patient wakes up after GA and complains of severe burning in one or both eyes...
You are called to deal with it...
Let's discuss why it happens... how to prevent it... and how to treat it

Great summary here:
http://www.psanes.org/Anesthesiolog...ClinicalUpdates/tabid/94/anid/29/Default.aspx

Especially liked the author's tip about not putting the pulse ox on the index finger - that's almost always the one pts use to rub their eyes.

 

[2ndyear]

This is something I seem to deal with at least a couple of times per week. I primarily supervise so I'm called in PACU. No idea how it happened. Pt is complaining of burning eye and usually a foreign body sensation. I do a brief exam, to make sure there is nothing there, and then treat. Topical ketorolac drops followed by e-mycin ointment that they take home. Instructed to follow up with PCP if not resolved by morning, provide our anesthesia contact number and let them know we're always here if they have problems/questions. I've never been called. If they've got transportation issues or have come from far away I offer them the services of our ED, and I've had several people prefer to go right there from PACU.

 

[nimbus]

This is something I seem to deal with at least a couple of times per week. I primarily supervise so I'm called in PACU. No idea how it happened. Pt is complaining of burning eye and usually a foreign body sensation. I do a brief exam, to make sure there is nothing there, and then treat. Topical ketorolac drops followed by e-mycin ointment that they take home. Instructed to follow up with PCP if not resolved by morning, provide our anesthesia contact number and let them know we're always here if they have problems/questions. I've never been called. If they've got transportation issues or have come from far away I offer them the services of our ED, and I've had several people prefer to go right there from PACU.

That seems like an excessively high incidence. I've been involved in 3 cases in 17 years. All resolved at 24 hrs.

 

[pgg]

Obvious intraop prevention = eye taping. Ideally immediately after induction, especially if you're with a SRNA or resident or rotator who hasn't learned not to drag the ETT's attached syringe across the face when intubating.

I think the best thing we can do is simply good anesthesia. One facet of that is rapid emergence to meaningful wakefulness when we're present, so the patients aren't emerging in the PACU when we're gone, when the PACU nurse may or may not be there to grab the patient's eye-rubbing hands. Of course there are cases when this isn't possible, but we all know some people whose routine 35 yo lap choles get to the PACU obtunded with an oral airway. My guess is their patients are at much higher risk of eye injury.

Minimize the window of risk (disoriented patient) and be present during that window if possible.


I also like the pulse-ox not on the index finger idea.

 

[Planktonmd]

Obvious intraop prevention = eye taping. Ideally immediately after induction, especially if you're with a SRNA or resident or rotator who hasn't learned not to drag the ETT's attached syringe across the face when intubating.

I think the best thing we can do is simply good anesthesia. One facet of that is rapid emergence to meaningful wakefulness when we're present, so the patients aren't emerging in the PACU when we're gone, when the PACU nurse may or may not be there to grab the patient's eye-rubbing hands. Of course there are cases when this isn't possible, but we all know some people whose routine 35 yo lap choles get to the PACU obtunded with an oral airway. My guess is their patients are at much higher risk of eye injury.

Minimize the window of risk (disoriented patient) and be present during that window if possible.


I also like the pulse-ox not on the index finger idea.

I actually think that the way some CRNA's tape the eyes is directly responsible for these problems.
Some CRNA's tape the eyes so tight as if they were taught that eyeballs could become loose under anesthesia and could fall out!
Also female patients showing up with heavy eye makeup as if they are going to a party is another annoying phenomena.

 

[urge]

I have seen people tape the eyes when they are wide open. Can't make that one up. I only remember 1 incident of corneal abrasion. We had fluorecein and a woods lamp in that institution. Erythromycin cream and off you go.