Preventing Corneal Abrasions: More Than “Don’t Rub Your Eyes”

Tired exhausted man suffering from strong eye pain, touching red painful eye, monochrome photo

Situation:

  • Corneal abrasions, although infrequent (0.03-0.17 percent of cases), continue to occur
  • Distressing to patients and the most common ocular injury in the perioperative period
  • Mechanically ventilated ICU patients are also at risk, with an incidence as high as 60 percent

Background: 

  • Due to disruption in corneal epithelium
  • Contributing mechanisms include:
    • Lagophthalmos
    • Loss of Bell’s phenomenon and blink reflex
    • Natural pain responses blunted with analgesia and anesthesia
    • Decrease in tear production
    • Desiccation from oxygen
    • Foreign matter in eye
    • Trauma from face masks, dangling id badges, linens, patient rubbing eyes, inadvertent pressure, chemicals (prep solution), etc.
    • Prone position
    • Prolonged surgery
    • Inadequate eye protection

Assessment:

  • Common signs and symptoms include unilateral eye pain, scleral injection/erythema, photophobia, sensation of foreign body, discomfort aggravated by blinking
  • If minor, prognosis is usually excellent
  • Larger abrasions can lead to visual disturbances, corneal scarring, blindness

Recommendations:

  • Prevention!
    • Review of patient eye problems prior to surgery
    • Removal of contact lenses and eye makeup pre-operatively
    • Eyes closed and securely taped immediately after induction of anesthesia
      • Tape horizontally
      • Occlusive, transparent dressings (such as Tegaderm) are a good option for long procedures
      • Ophthalmic lubricant use remains controversial
    • Check eyes frequently to make sure they are staying taped and closed
    • Remove eye tape carefully; adhesive can abrade the eyelid
    • Place pulse oximeter probe on ring or little finger of the non-dominant hand to decrease inadvertent eye contact should patient rub eyes on emergence
    • Awareness and protection of eyes during MAC cases and with any oxygen use, including ICU patients
    • “Don’t rub your eyes” patient reminders following emergence from anesthesia
  • Occurrence –> prompt treatment that may include Ophthalmology consult/referral
    • Utilize “Corneal Abrasion Management Protocol” – posted in PACUs
    • Utilize “Corneal Abrasion Order Set”

References:

  • Palte, HD. Revisiting Perioperative Corneal Abrasion. ASA Monitor 2018; 82:22–25
  • Corneal abrasion perioperative. In: UpToDate, Post TW, ed. UpToDate.  UpToDate;2022
  • Papp AM, Justin GA, Vernau CT, Aden JK, Fitzgerald BM, Kraus GP, Legault GL. Perioperative Corneal Abrasions After Nonocular Surgery: A Systematic Review. Cornea. 2019 Jul;38(7):927-932. doi: 10.1097/ICO.0000000000001972. PMID: 31033698.
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