Anesthesia and Eye Diseases: Reply.

Abstract

We appreciate the interest shown by Dr. Priebe1 in our review article in Anesthesiology.2 They have provided a valuable caveat to what we wrote with respect to prevention of corneal abrasions. Dr. Priebe1 is correct that the eyes should be properly covered immediately after loss of the eyelid reflex after induction of anesthesia. This should prevent corneal abrasion caused by objects inadvertently contacting the eye during endotracheal intubation. Using this routine, together with an educational program, as referenced by Dr. Priebe,1 reduced the incidence of corneal injury after anesthesia from 1.51 per 1,000 to 0.79 per 1,000.3 However, corneal injury also includes exposure keratopathy (in our review, we used this term since the distinctions between exposure keratopathy and corneal abrasion may be somewhat arbitrary). Interestingly, the authors of this report found that risk factors for corneal injury included the length of surgery, as well as the performance of the anesthetic involving a nurse anesthesia trainee. In our earlier study from 1996,4 we also found risk factors of increased length of surgery, lateral positioning, head or neck surgery, general anesthesia, and surgery on a Monday. Dr. Priebe1 correctly points out that some of these injuries may occur in the postoperative period. Patients awakening from anesthesia tend to rub or touch their eyes, much as people do upon wakening from sleep, and a clumsy placement of a finger into the eye can cause a corneal abrasion. Whether or not a pulse oximeter probe is a necessary condition to cause the abrasion remains uncertain. In our study, in only 21% of cases was a specific cause of injury identified, and therefore the exact cause of many of these injuries is often unclear.4Dr. Roth has provided expert witness testimony in cases of perioperative eye injuries on behalf of providers, hospitals, and insurance companies. The other authors declare no competing interests.