Perioperative Corneal Abrasions Research Articles

Risk stratification, prevention and management of perioperative corneal abrasion for non-ocular surgery: Systematic Review.

A corneal abrasion is a flaw in the cornea's epithelial surface, which is located in the front of the eye. It causes recurrent erosions, corneal inflammation, and chronic corneal defects. In a context with limited resources, the goal of this review was to provide an evidence-based procedure for perioperative risk stratification, prevention, and management of corneal abrasion during non-ocular surgery. A medical search engines of PUBMED, GOOGLE SCHOLAR, COCHRANE REVIEW, and PUBMED CENTERAL to get access for current and updated evidence on procedures on risk stratification, prevention and management of corneal abrasion for non-ocular surgery. The authors formulate the key questions, scope, and articles written in English language, human study focuses on corneal abrasion, articles in the last 20 year was implemented to identify or filter high-level evidences were included. Reports contain corneal abrasion due to ocular surgery were excluded. All the research articles, which were identified from searches of electronic databases, were imported into Endnote software, duplicate were removed advanced search strategy of electronic sources from databases and websites was conducted using Boolean operators (cornea AND (abrasion OR injury OR laceration)) AND ("Perioperative Period" OR "general anesthesia"). Screening of literatures was conducted with proper appraisal checklist. This review was reported in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement. From 8767 identified articles, two hundred articles were removed for duplication and 7720 studies were excluded, 1205 articles were retrieved and evaluated for eligibility. Finally, 24 were included in this systematic review. Advanced age, Prominent eyes, exophthalmus, ocular surface abnormalities (dry eye), expected duration of surgery (>1 h), the favourable position of the surgery, prone,Trendelenburg and lateral, risk of bleeding, surgical site of the surgery(head /neck) and diabetes mellitus were risk for corneal abrasion. The use of appropriate intervention with pharmacological and Non-pharmacological strategies minimizes the occurrence of perioperative corneal abrasion was crucial for the quality of care. Preventing and managing corneal abrasion improves patients' quality of life. However, there was insufficient evidence to draw conclusions, and high-quality trials of multimodal interventions matched to risk stratification and prevention of corneal abrasion needed to provide robust evidence to guide prevention and management of perioperative corneal abrasion.

Comparing the effects of vitamin A ointment and liposic gel on corneal abrasion prevention during general anesthesia in nonocular surgeries: a double-blind randomized clinical trial

Purpose The aim of this study was to compare the effects of vitamin A ointment and Liposic gel on perioperative corneal abrasion (CA) prevention during nonocular surgeries. Design A double-blind randomized clinical trial. Methods In this double-blind randomized clinical trial 50 eligible candidates for nonocular surgeries were purposively selected from XXX teaching hospital, XXX. One patient eye was randomly allocated to the vitamin A group and the other eye to the Liposic gel group. Immediately after anesthesia induction and blinking reflex suppression, eye care was provided using vitamin A ointment in the vitamin A group and Liposic gel in the Liposic gel group. CA was assessed using the fluorescein eye stain test at the end of general anesthesia, at the end of postoperative recovery, and 24 h after surgery. Eye problems were also assessed 24 h after surgery using an eye problems questionnaire. The SPSS software (v. 23.0) was employed for data analysis through the Wilcoxon’s, paired-sample t, and Friedman’s tests as well as the repeated measures analysis of variance. Findings The prevalence of CA in the vitamin A and the Liposic gel groups was 32 and 50% at the end of general anesthesia (P=0.039), 32 and 52% at the end of postoperative recovery (P = 0.018), and 0 and 0% 24 h after surgery (P = 1.00), respectively. There were no significant between-group differences respecting postoperative eye problems (P > 0.05). Conclusion Vitamin A ointment is more effective than Liposic gel in significantly preventing CA among patients undergoing non-ocular surgeries under general anesthesia.

Efficacy of Eyelid Taping with and without Ocular Lubricants in Patients Receiving General Anaesthesia: A Prospective Interventional Study

Introduction: Corneal Abrasion (CA) is the most common ophthalmic complication that occurs after General Anaesthesia (GA) in non ocular surgeries. GA results in reduced basal tear volume, loss of light reflex, and lack of pain perception, resulting in corneal drying. This makes the cornea susceptible to abrasion and keratitis. Research suggests that preventing corneal mechanical exposure and providing artificial tears can help mitigate these risks. Aim: The aim of this study was to assess the efficacy of eye taping with and without Hydroxypropyl Methylcellulose (HPMC) drops in preventing perioperative CA. Materials and Methods: This prospective comparative interventional study was conducted in the Department of Anaesthesia, Justice Hegde KS Charitable Hospital in Mangaluru, India, from June 2021 to November 2021. A total of 122 patients who underwent GA for non ocular surgeries lasting more than 45 minutes were grouped into group T or group D, depending on whether their eyes were only taped during GA (T) using hypoallergenic adhesive tape or had HPMC drops instilled in their eyes along with tape (D). Participants were evaluated 2 and 12 hours after the end of GA in the postanaesthesia care unit using a questionnaire to assess eye symptoms. Conjunctival hyperaemia and chemosis were evaluated using scoring systems. Other parameters noted included age, gender distribution, type, and duration of surgery. Statistical analysis using the chi-square test/likelihood ratio was performed to assess the association between the eye protection method used and postsurgical outcomes. Results: Out of the 122 patients who received either of the two eye protection methods under GA, 68 (55.7%) were females and 54 (44.3%) were males. A total of 85 (69.6%) were between the ages of 20-60 years, while 29 (23.8%) were above the age of 60 years. There was no statistically significant association found between the age or gender of the patients and the eye protection method used. No statistically significant difference was noted between the duration, type of surgeries, and the eye protection method used in this study. There was no statistical significance (p-value>0.05) noted with respect to the conjunctival hyperaemia and chemosis scoring in the two groups. However, 15 (24.6%) patients in group D were found to have adhesive lids two hours postsurgery. There was an association (p-value<0.05) between the occurrence of adhesive lids at two hours postsurgery and the eye protection method used. Conclusion: Eye protection is mandatory in all non ophthalmic cases under GA. Both eyelid taping alone and eyelid taping with HPMC drops are equally effective in preventing perioperative ocular injury

Perioperative corneal abrasions: A report of 42 cases from the webAIRS database.

Corneal abrasions are an uncommon complication of anaesthesia. The aim of this study was to identify potential risk factors, treatment and outcomes associated with corneal abrasions reported to the web-based anaesthesia incident reporting system (webAIRS), a voluntary de-identified anaesthesia incident reporting system in Australia and New Zealand, from 2009 to 2021. There were 43 such cases of corneal abrasions reported to webAIRS over this period. The most common postoperative finding was a painful eye. Common features included older patients, individuals with pre-existing eye conditions, general anaesthesia and procedures longer than 60 minutes. Most cases were treated with a combination of lubricating eye drops or aqueous antibiotic eye drops. The findings indicate that patients who sustain a perioperative corneal abrasion can be reassured that in many cases it will heal within 48 hours, but they should seek earlier review if symptoms persist or deteriorate. None of the cases in this series resulted in permanent harm. Well established eye protective measures are important to utilise throughout the perioperative period, including the time until the patient has recovered in the post-anaesthesia care unit.

A Quality Improvement Project to Decrease Perioperative and Periprocedural Corneal Abrasions

PurposeWe assessed our institution's rate of perioperative and periprocedural corneal abrasions (CAs) and implemented a quality improvement project to improve our detection of CAs and decrease their incidence by at least 25% over 12 months. DesignRetrospective review before and after initiation of a quality improvement project at a single tertiary care institution MethodsWe retrospectively reviewed surgical and procedural patients requiring any type of anesthesia care over three 1-year time periods (2014-2015, 2016-2017, and 2017-2018). Using an electronic pharmacy-based query to identify patients who received proparacaine eye drops in the recovery room, we were able to estimate our incidence of CA during these time periods. We implemented a best practice plan to standardize CA prevention, diagnosis, and treatment after determining our baseline incidence of CA. FindingsOur baseline incidence rate of perioperative and periprocedural CAs was 0.22% (43/19,790 anesthetics) in the 2014-2015 time period. In the 2016-2017 and 2017-2018 time periods, the incidence rate was reduced to 0.09% (21/23,652 anesthetics) and 0.1% (23/23,825 anesthetics), respectively. The use of a standardized CA prevention, diagnosis, and treatment plan reduced the relative risk of CAs by 59% in 2016-2017 (P < .001) and 56% in 2017-2018 (P = .001) compared to baseline, with an absolute reduction of 13% and 12% over those time periods. ConclusionOur data suggests that the adoption of a simple, standardized perioperative and periprocedural CA prevention, diagnosis, and treatment plan can result in sustained reductions in the occurrence of perioperative CAs.

Perioperative Corneal Abrasions After Nonocular Surgery: A Systematic Review.

To perform a systematic review of the international literature evaluating the risk factors, preventative steps, and treatments for perioperative corneal injuries for nonocular surgery. PubMed, Embase, and Evidence-Based Medicine Reviews databases were searched on April 13, 2018. Two hundred four articles were identified with 16 meeting the inclusion criteria. All studies were evaluated for quality and level of evidence. Two types of studies were included. The first were primary epidemiological studies that looked at the rates of perioperative corneal injuries after nonocular surgery and the second were trials that either studied preventative steps or treatments. A statistical analysis was completed to reveal trends in perioperative corneal abrasions. Rates ranged from 0.01% to 59% with a cumulative rate of 0.64% (95% confidence interval 0.36%-1.35%). Primary risk factors were identified as longer procedures, general anesthesia, and advanced age. The most commonly associated ocular injuries were found to include chemical injury, conjunctivitis, blurred vision, and conjunctival congestion. Treatment strategies for corneal abrasion in the literature recommended erythromycin ointment and ample ocular lubrication for the fastest recovery. Education interventions alone, as studied in 2 of the 16 articles, demonstrated a significant decrease in the rate of corneal abrasions. Standardized ocular protection, reporting, and education initiatives were found to maximally decrease rates of perioperative corneal abrasions after nonocular surgery. However, no gold standard currently exists for intraoperative ocular protection. More research needs to be conducted on specific prevention strategies and content of educational initiatives in hopes of standard development across facilities nationwide.

Corneal abrasion following anaesthesia for non-ocular surgical procedures: A case-controlled study.

The aim of this study was to identify risk factors associated with perioperative corneal abrasion at a single hospital in Mineola, New York (United States). A chart review was conducted of patients with perioperative corneal abrasion following non-ocular surgery and age-matched controls between June 2011 and November 2013. An age-stratified logistic regression model evaluated the association between corneal abrasion and potentially predisposing variables. The adjusted odds of a corneal abrasion occurring were 4.6 times greater for patients having surgery for ≥ 3 hours (p=0.001) and 3.6 times greater for patients with pre-existing ocular disease (p=0.02). Gender, diabetes status, surgical procedure or position were not found to be associated with the occurrence of a corneal abrasion. Corneal abrasions were associated with longer procedures and history of pre-existing ocular disease. No significant association between body positioning or surgical site and perioperative corneal abrasion was found. The study concludes that a longer duration of surgical procedure and pre-existing ocular disease are risk factors for perioperative corneal abrasion.

Mechanisms of perioperative corneal abrasions: Alterations in the tear film proteome

Mechanisms of perioperative corneal abrasions: Alterations in the tear film proteome

Alterations in Tear Biochemistry Associated with Postanesthetic Chronic Dry Eye Syndrome.

Perioperative dry eye syndrome (DES) is a common ocular complication of long-term general anesthesia. Chronic DES can lead to permanent damage to the cornea and disturbance of visual function, up to total loss of vision. Here, a relationship between the duration of general anesthesia and the risk of chronic DES in patients was demonstrated. Using an experimental model of perioperative corneal abrasions in rabbits, it was found that introduction of animals to 3-h general anesthesia resulted in clinically significant chronic damage to the cornea in 50% of cases. The development of the complication was not associated with irreversible or long-term impairment of tear secretion, but it was accompanied by a decrease in tear film stability and growth of the total protein content as well as decrease in total antioxidant activity of the tear induced by low molecular weight antioxidants. In addition, anesthesia-induced changes in activity of tear antioxidant enzymes including superoxide dismutase and enzymes providing homeostasis of reduced glutathione (glutathione peroxidase, glutathione-S-transferase, glutathione reductase) were observed. All these alterations were protracted (up to 1-2 weeks) and therefore might account for transition of the perioperative DES into the chronic form. These findings can be useful in the development of novel approaches for the prevention and treatment of chronic forms of DES in the postanesthetic period.

Perioperative Corneal Abrasion: Updated Guidelines for Prevention and Management

Corneal abrasion is the most common ocular complication in surgery. Treatment requires pain control, antimicrobial prophylaxis, and close monitoring. Pain improves significantly after 24 hours and should be resolved by 48 hours. Persistent, worsening, or new symptoms warrant immediate specialist consultation. The authors review the pathophysiology of perioperative corneal abrasion, and propose updated evidence-based guidelines for improved patient care.

Mechanisms of perioperative corneal abrasions: alterations in tear film proteome

Perioperative corneal abrasion is an ophthalmic complication commonly found in patients underwent general anesthesia. In this study, correlations between development of corneal injury and proteomic changes in tear film during general anesthesia were examined using an animal (rabbit) model. Being started after 1-h anesthesia, the process of accumulation of pathological changes in the cornea unequivocally led clinically significant abrasions following 3-6 h of the narcosis. The corneal damage was associated with alterations in profiles of major proteins of the tear film. Analysis of the tear proteome pointed to depression of lachrymal glands function, and suggested serotransferrin, serum albumin and annexin A1 as potential tear markers of the complication. The tear film alterations included fast drop of total antioxidant activity and activity of superoxide dismutase, and decrease in interleukin-4 and increase in interleukin-6 content indicating development of oxidative and pro-inflammatory responses. These findings suggest antioxidant and anti-inflammatory therapy as prospective approach for prevention/treatment of perioperative corneal abrasions. The observed anesthesia-induced effects should be considered in any study of ocular surface diseases employing anesthetized animals.

Evaluation and Treatment of Perioperative Corneal Abrasions

Purpose. To evaluate perioperative risk factors for corneal abrasion (CA) and to determine current care for perioperative CA in a tertiary care setting. Methods. Hospital-based, cross-sectional study. In Operating Room and Post-Anesthesia Care Units patients, a comparison of cases and controls was evaluated to elucidate risk factors, time to treatment, and most common treatments prescribed for corneal abrasions. Results. 86 cases of corneal abrasion and 89 controls were identified from the 78,542 surgical procedures performed over 2 years. Statistically significant risk factors were age (P = 0.0037), general anesthesia (P < 0.001), greater average estimated blood loss (P < 0.001), eyes taped during surgery (P < 0.001), prone position (P < 0.001), trendelenburg position (P < 0.001), and supplemental oxygen en route to and in the Post-Anesthesia Care Units (P < 0.001). Average time to complaint was 129 minutes. 94% of cases had an inpatient ophthalmology consult, with an average time to consult of 164 minutes. The most common treatment was artificial tears alone (40%), followed by combination treatment of antibiotic ointment and artificial tears (35.3%). Conclusions. Trendelenburg positioning is a novel risk factor for CA. Diagnosis and treatment of perioperative corneal abrasions by an ophthalmologist typically require three hours in the tertiary care setting.

Corneal Protection during General Anesthesia for Nonocular Surgery

Corneal abrasion is the most common ophthalmologic complication that occurs during general anesthesia for nonocular surgery. Such abrasions can be caused by a variety of mechanisms and can lead to sight-threatening microbial keratitis and permanent scarring. There is no standard mode of protecting the cornea during general anesthesia for nonocular surgery. Methods described in the literature are not entirely effective and may be associated with unwanted side effects. Taping alone provides protection that is equivalent or superior to other interventions and has fewer side effects. Petroleum gel is flammable and is best avoided when electrocautery and open oxygen are to be used around the face. Preservative-free eye ointment is preferred, as preservative can cause corneal epithelial sloughing and conjunctival hyperemia. Recently, the application of Geliperm and bio-occlusive dressings has been advocated. Geliperm may be particularly useful during endonasal surgery when continuous perioperative observation of the eye is required. In this article, the literature on the etiology of perioperative corneal abrasions is reviewed and various protection strategies are compared in order to identify the best methods to prevent corneal abrasions during general anesthesia.

Detection and Treatment of Perioperative Corneal Abrasions

Corneal abrasion is the most common ocular injury occurring in the perioperative period. Corneal abrasion may occur during general anesthesia, monitored anesthesia care, regional anesthesia, or in the immediate recovery period. This injury is not usually apparent until the patient is in the PACU, and the perianesthesia nurse may be the first clinician to detect this complication. Preventive measures and vigilant care can help reduce the incidence of corneal abrasion in susceptible patients. Early detection and prompt intervention may help reduce the incidence of ocular morbidity. The purpose of this article is to explore the incidence, mechanism of injury, prevention, recognition, and treatment of perioperative corneal abrasion.

Detection and Treatment of Perioperative Corneal Abrasions 2.0 Contact Hours

Detection and Treatment of Perioperative Corneal Abrasions 2.0 Contact Hours