who should handle corneal abrasions?

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Covering surgical floors today and got called to see a patient s/p knee surgery who was suspected of having a corneal abrasion. The nurse said she had called anesthesia first and they said to call surgery. I was under the impression that corneal abrasions in this setting should be dealt with by the anesthesia team. Am I wrong? Or is this becoming another relm of other specialties doing things and dumpign the complicatioins on surgery?
 
if i suspect corneal abrasion, i have optho see the patient in the pacu.
 
My guess is that the anesthesiologist defer ordering consults to the pts primary team - which is the surgeons (and a point I agree with). Personally, if my pt gets a corneal abrasion (which happens) I like the anesthesiologists to see the pt as well as the obligatory optho consult (for management). Any complication from our interventions (including general anesthesia) really should be seen by the person who caused it in an effort to reduce the chances of it happening again.
 
At our institution, real corneal abrasions seem to be diagnosed in the PACU, in which case we (the anesthesiologists) would call ophtho. They're typically painful enough that it'd be surprising that a patient could get an abrasion perioperatively and not raise the issue until they get all the way to the floor. We do, however, see chemosis, swelling of the conjunctivae, sclerae, and lids, often as a result of extreme positioning (steep trendelenburg for prostates, prone for spines), which can be irritating but not so painful that they always bring it up right away.

In any case, the anesthesiologist should be made aware, and a diagnosis should be made by an ophthalmologist. Who actually makes the phone call is probably a matter of timing and institutional culture.

We recently had a run of "eye injuries" associated with robotic prostate surgeries (STEEP t-berg), most of which were probably not real abrasions, but rather chemosis. Without the urologists pointing the cases out to us, we wouldn't have uncovered the pattern and identified that 1) these probably weren't true abrasions and 2) some of the risk factors (patterns of fluid replacement, styles of eye taping) that might exacerbate the problem.
 
I see my patients with corneal abrasions post op...

I prescribe topical toradol for 24 hours....

follow up in 24 hours....never had anyone needing to go see an opthalmolgist in 4 years of PP.
 
We get the optho consult, and pay for it. It's a "CYA" thing.

-copro
 
The patient I was called for had an outpatient procedure, and was in the secondary PACU. Had met all d/c criteria. The nurse said she called anesthesia first, and was told to call surgery. I should note this happened in a moonlighting type job, (not in a resident role) kind of a floater to deal with random issues. A PA does this during day hours, with moonlighting residents and people transistioning from surgery to other specialties covering nights and weekends. I found out later that the PA's always do a fluroscien (sp?) exam and prescribe eye gtts, and ophtho typically not called...not much ophtho at this institution. I was floored that the anesthesia group seemed to not want to be involved. Also I've never had any training for how to do the exam...I'm sure it's not hard, but still made me wonder about liability.
 
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