Perioperative Eye Injuries - Types, Symptoms, and Treatment

Introduction

Perioperative eye injuries occur during a surgical procedure and cause the patient discomfort and pain in the eye. Eye injuries are not common in surgical procedures, but if they occur, they are a great concern for the patient. Perioperative eye injuries can occur in any ocular or non-ocular surgery. These eye injuries resolve within two to three days.

What Is Perioperative Injury?

Perioperative means around the time of surgery. Perioperative injury means an unexpected outcome, a complication that occurs during the surgery.

What Are Perioperative Eye Injuries?

Perioperative eye injuries are unexpected and painful outcomes that occur during surgery. These occur very rarely and can lead to discomfort and anxiety for the patient. Perioperative eye injuries are commonly seen in anesthetic practices. These are great concerns for the patient; after the surgery, they may complain of blurred vision, tearing, redness, photophobia, and the sensation of a foreign body in the eye. The most common perioperative eye injuries include corneal abrasion, conjunctivitis, prolonged blurred vision, and blindness.

What Are the Factors Responsible for Perioperative Eye Injuries?

• Increased age of the patient.

• Type of anesthesia received.

• Length of surgery.

• Prone Positioning.

• The exact cause of perioperative injuries is unknown, and aberrations occur secondary to mechanical engineering.

What Is a Corneal Abrasion?

Corneal abrasion is a common perioperative eye injury, which is a cut or scratch in the cornea caused by trauma, the presence of foreign objects that occur during the surgery. The exact cause of corneal abrasion is not known. The patients fail to close their eyes naturally under general anesthesia. The cornea is exposed to air and becomes dry. The dry cornea gets stuck to the inside of the eyelid. The abrasion occurs when the eyes are opened at the end of surgery. Corneal abrasion can also occur when some objects come in contact with the dry

exposed cornea during surgery. Ensuring both eyes are closed during the surgery can protect the eyes. The purpose of preventive guidelines is to provide safe and effective treatment for the patient and to avoid any possible corneal injury.

Preventive Measures:

• Taping the eyes during eye surgery provides enough protection. The lids should be closed fully and not allow the eyelashes to fall into the conjunctiva.

• Tape is placed horizontally across the entire eyelid. The taping should be done after the loss of the eyelid reflex and before securing the airway.

• If eye drops are used, make sure to use paraffin-free solutions. Paraffin-based ointments may cause morbidity and should be avoided.

• Water-based viscous eye drops reduce corneal abrasion when tape alone is used.

What Are the Signs and Symptoms of Corneal Abrasion?

• Itching.

• Burning sensation.

• Stinging.

• Foreign body sensation.

• Painful eye.

• Increased pain while blinking.

• Photophobia.

• Blurred vision.

• Redness of the eye.

• Excessive tearing.

• Miosis.

What Is the Treatment for Corneal Abrasion?

• Proper examination of both eyes with a flashlight.

• Fornices is a loose soft tissue at the junction connecting the palpebral and bulbar conjunctival membranes. It is examined by asking the patient to look in all directions.

• If eyelashes or foreign are present in the eye, irrigate the eye with saline, and observe whether the symptoms are resolving or not.

• If foreign bodies are not evident, the use of topical ophthalmic antibiotics provides symptomatic relief.

• Use of Mydriatics (medicines that open up the pupil) is not advised.

• Do not cover the affected eye.

• Discontinue the use of contact lenses if symptoms persist.

• Contact the ophthalmologist if the symptoms continue after two days.

• Patients with associated risk factors should be monitored regularly.

Prognosis:

• In most cases of corneal injury, the pain and discomfort decrease after 24 hours and completely resolve after three to four days.

• Long-term complications are absent. The progression of corneal ulceration or infection is rare.

What Are the Perioperative Eye Injuries That Occur During General Anesthesia?

• Increased pressure on nerves in the eyebrow region can cause droopy eyelids. This is a temporary change that recovers soon after the surgery.

• The protective tape and eye ointments used for the prevention of perioperative injuries can cause temporary bruising and irritation to the eyes.

• The surgeries carried out in head down position can lead to swelling of eyelids, which will resolve after a short time.

• In patients with glaucoma, the intraocular pressure is high, and extra care is taken to protect eyesight during surgery.

How Permanent Loss of Vision Occurs During Eye Surgeries?

• Vision loss during eye surgeries under general anesthesia is very rare. It occurs due to damage to two important structures of the eye, the retina, and the optic nerve. The retina is the light-sensitive area of the eye, and the optic nerve carries visual information from the eyes to the brain.

• Causes - low blood pressure during the surgery, resulting in a lack of oxygen supply to the retina or optic nerve.

• Tiny clots in the retinal blood vessels cause a lack of oxygen to the optic nerve or retina.

• Increased eye pressure on the eyeball can damage the optic nerve, and blood supply to the optic nerve and retina is blocked.

What Are the Surgical Procedures With a Higher Risk of Perioperative Eye Injury?

• Operations on the spine in the prone position and head down, take more than six hours, with blood loss.

• Surgeries that require cardiopulmonary bypass.

• Neck dissection operations.

These above-mentioned surgical procedures have a high risk of eye injury due to increased ocular pressure. Anesthetists continuously monitor the blood pressure, and proper steps are taken to maintain the appropriate level and thereby prevent excess pressure on the eyeballs.

What Are the Recommendations for Preventing Perioperative Eye Injury?

• Careful taping of the eyelids after giving general anesthesia.

• Awareness about hanging or swinging objects when coming in close to the patient's eyes.

• Avoid direct pressure on the eyes.

• Frequently check the eye when the patient is in the prone position.

• Post-operative evaluation of the eye should be done.

Conclusion

While performing a surgical procedure, all possible measures have to be taken to protect the eyes. In ocular and nonocular surgeries, possible perioperative injuries are assessed, and adequate measures are adopted. Eye injuries subside within three days, leaving zero complications. The health condition of the patient is also evaluated before surgery. Eye injuries causing serious discomfort and vision loss require immediate medical attention.