THE INJURED EYE

Abstract

Approximately 2 million eye injuries occur in the United States annually. Eye trauma is the fourth most common cause of visual loss in people under the age of 45 and the leading cause of noncongenital blindness in patients under 20 years of age.40, 43, 54 Eye trauma, with its very real threat of loss of vision, can be psychologically devastating. The sudden nature of trauma does not allow the patient time to adjust to the reality and consequences of the injury. The types of eye trauma that may require surgical repair include blunt trauma, perforating injury, foreign body injury (including gunshot wounds), thermal injury, animal bites, self-inflicted wounds, and child abuse. Sports injuries are a major cause of trauma to the eye; each year 40,000 sports-related eye injuries are treated in hospital emergency rooms. In the United States, racquet sports cause almost one third of all sports-related eye injuries to athletes between the ages of 25 and 65. Baseball is the most common cause of eye injury in children between the ages of 5 and 15 years.43, 54 The nature of ophthalmologic surgery is not life-threatening; therefore, the mortality associated with anesthesia should be low and reflect the patient's physical status. The challenge to the anesthesiologist is twofold: to care for the patient with an eye injury in the setting of multisystem trauma and to preserve vision by favorably manipulating anatomic and physiologic variables as they relate to the eye (Fig. 1). During surgery, proper anesthetic management can control intraocular pressure (IOP), provide optimal operating conditions, and contribute to a successful surgical outcome.