Corneal abrasion - NYSORA

Explore NYSORA knowledge base for free:

Table of Contents

Contributors

Corneal abrasion

Corneal abrasion

Learning objectives

  • Describe the causes and risk factors for corneal abrasion
  • Prevent corneal abrasion
  • Manage corneal abrasion occurrence

Background

  • Corneal abrasion is the most common ophthalmologic complication in patients undergoing general anesthesia for nonocular surgery
  • Can result in eye pain or soreness in response to bright light
  • May develop into inflammation or ulcers by infection of bacteria or fungi on the scar
  • Postoperative pain can be more severe than 

Causes

Mechanical injuryDirect contact with drapes, masks, or other equipment/items
Inadvertent pressure on the eyeball
Loss of pain perception and inhibition of protective corneal reflexes further increase risk
Chemical injurySpillage of antimicrobial solutions into the eyes during skin preparation
Contact with cleaning solutions retained on the anesthetic mask
Ocular hypersensitivity to inhaled anesthetic agents (e.g., halothane)
Antiseptic solutions containing detergents or alcohol
Exposure keratopathySedatives and neuromuscular blocking agents inhibit active contraction of the orbicularis oculi muscle, resulting in incomplete eyelid closure, corneal exposure, and dryness
Correlated with the duration of corneal exposure
Reduced tear productionGeneral anesthesia suppresses the autonomic nerve supply to the lacrimal gland
Specific drugs (e.g., beta-blockers, hydrochlorothiazide) inhibit tear production
Ocular hypoperfusion secondary to deliberate hypotension
Anesthetic gases delivered via face mask add to corneal dehydration
General anesthesia inhibits the blink reflex and redistribution of tears over the ocular surface
Bell’s phenomenon (upward rotation of the eyeball to protect the cornea during sleep) is absent during anesthesia

Risk factors

  • General anesthesia
  • Lower ASA status
  • History of dry eyes
  • Advanced age
  • Proptosis or exorbitism
  • History of corneal trauma
  • Longer procedures 
  • Preoperative anemia
  • Prone, lateral or Trendelenburg position
  • Procedures near head/neck
  • Intraoperative hypotension

Prevention

  • Eyelid taping immediately after induction (preferred method)
  • Ocular lubricants (fat-based ointments are retained longer than aqueous solutions but pose a higher risk of complications)
  • Hydrogel dressings
  • Bio-occlusive dressings
  • Continuous perioperative eye monitoring

Management

corneal abrasion, eye exam, vision loss, visual acuity, pain, refractive eye disease, fluorescein dye, foreign body, artificial tears, erythromycin, ophtalmology

Suggested reading

  • Hewson DW, Hardman JG. Physical injuries during anaesthesia. BJA Educ. 2018;18(10):310-316.
  • Malafa MM, Coleman JE, Bowman RW, Rohrich RJ. Perioperative Corneal Abrasion: Updated Guidelines for Prevention and Management. Plast Reconstr Surg. 2016 May;137(5):790e-798e.
  • Lichter JR, Marr LB, Schilling DE, et al. A Department-of-Anesthesiology-based management protocol for perioperative corneal abrasions. Clin Ophthalmol. 2015;9:1689-1695. Published 2015 Sep 11
  • Grixti A, Sadri M, Watts MT. Corneal protection during general anesthesia for nonocular surgery. Ocul Surf. 2013;11(2):109-118.

We would love to hear from you. If you should detect any errors, email us customerservice@nysora.com

Upcoming Events View All