Anesthesia Considerations 

Corneal Abrasions

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Background​

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• Definition: Injury to the epithelial layer of the cornea (4-6 cell layers thick); the outermost layer of the globe of the eye

  • Cornea is avascular and very densely innervated

  • Most common ocular complication in surgery (0.01-0.1% incidence)

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Considerations​

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• Signs/symptoms: pain, tearing, blurry vision, photophobia

• Risk factors:

  • General anesthesia

  • Hx of dry eyes

  • Advanced age

  • Proptosis or exorbitism

  • Hx of corneal trauma

  • Longer procedures >60 mins

  • Pre-op anemia

  • Prone, lateral or Trendelenburg position

  • Procedures near head/neck

  • Intra-op hypotension

• Potential Sources (true cause is often unknown):

  • After induction:

    • laryngoscope, face mask, watch, ID badge

  • Before incision:

    • surgical prep, gauze/sponges, surgical drapes

  • During procedure:

    • instruments, chemical solutions, heat sources, globe pressure, eye shields

  • Extubation:

    • O2 mask, patient fingers

• Diagnosis:

  • Ophthalmology consult for slit lamp exam to rule out more serious injury (i.e. penetrating injury)

  • Corneal abrasion dx confirmed with fluorescein exam of the ocular surface under blue light

 

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Prevention​

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• Staff education about eye care

• Secure eye lids in closed position after induction

  • Use Tegaderm/OpSite > tape in high risk patients

• Use of preservative-free ocular lubricants

 

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Management

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• Corneas heal on their own without scar formation within 72 hrs

• Goal is to minimize pain & prevent infection

  • Pain typically improves within 24-48 hrs

  • If not improving, need to rule out infection / missed dx

• Pain management:

  • Oral NSAIDs PRN

  • Preservative-free 0.5% methylcellulose lubricant drops PRN

  • Topical anesthetics (e.g. 1% tetracaine HCl)

  • Persistent pain >24-48 hrs should warrant ophthalmology

• Infection prevention:

  • topical antibiotics x 2-3 days (e.g. Erythromycin 0.5% ointment)

• Avoid:

  • eye patches

  • topical NSAIDs

  • topical steroids

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References​

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• 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. doi: 10.1097/PRS.0000000000002108. PMID: 27119941.