Be Aware of the Patient with an Eye Patch

Abstract

To the Editor: A 78-yr-old woman was scheduled for right upper lobectomy under general anesthesia. She weighed 54 kg and was 5 feet 10 in. tall. Her medical history was significant for hypertension, a 50-yr history of cigarette smoking, and an enucleation of the right eye for an unknown tumor 10 years previously. She had a glass eye but preferred to wear a large black (pirate) eye patch that covered the entire orbit including the eyebrows. Her physical examination was unremarkable with a class 2 airway. After induction of anesthesia with fentanyl and thiopental, vecuronium was given for muscle relaxation. Mask ventilation with sevoflurane in 100% oxygen proved difficult as a large leak was detected around her face. A new larger and well-inflated face mask was placed on her face but a large leak was still detected. A second anesthesiologist assisted by holding the mask with both hands, but the leak was still present. Only by increasing the fresh gas flow to 12 L were the lungs ventilated adequately despite the leak. A repeat pressure leak test of the anesthetic machine was done but no abnormality was seen. The cause of the problem was discovered when the eye patch was removed. The orbital cavity had no glass eye and an anatomical passage from the mouth cavity to the orbit of the eye was clearly seen. The problem was easily solved by packing the orbit with a 4 in. moist vaginal pack. Be aware of the patient with an eye patch. Should it be difficult to ventilate via mask due to a large orbital leak a moist vaginal pack can be used.