Eye Injury: Risk Factors

• The incidence of eye injuries while under anesthesia is low; corneal abrasions may be the most likely type. Ischemic optic neuropathy (ION) also occurs rarely.
• Associated risk factors for corneal abrasion include long surgical procedures, lateral positioning, and head and neck surgery.
• Risk factors associated with ION may include hypotension, hemorrhage, venous obstruction, and vascular occlusive disease (e.g., diabetes, arteriosclerosis).
• Although the mechanisms of injury are not well-understood, some preventative strategies may be beneficial and will be instituted:

Corneal Abrasion: Prevention

• Pulse oximeter probes should be applied to the middle, ring, or preferably little finger (but never index finger) in order to minimize the likelihood of corneal abrasion as patients emerge from anesthesia and raise hands to eye area.
• Consider Eye Occlusion, Ophthalmic Ointment:

• In all general anesthesia cases, except those where other specific measures are indicated such as transconjunctival approaches or oculoplastic procedures, the eyes should be taped shut with paper tape or ocular occluders.
• During procedures in the immediate periorbital region, such as external ethmoidectomies or frontal sinus operations where the eyes need to be exposed but not specifically opened, the lids may be sewn shut with a tarsorrhaphy type stitch placed at the lateral limbus.
• When the eyes are taped shut, great care should be taken so that they are completely and securely closed.
• When tape is removed it should be pulled from superior to inferior.

• There is no well-studied, proven benefit in using ointment. It’s use should be considered optional. However, patients in high-risk groups may benefit.
• When ointment is used, great care should be taken during the instillation of Lacri-Lube so that the cornea is not abraded with the tip of the applicator.

Ischemic Optic Neuropathy: Prevention

• Avoid intraoperative external pressure on globe of eye
• Minimize micro- and macroemboli during cardiopulmonary bypass
• Minimize hypotension and anemia in at-risk groups.

Eye Injury: Management

If corneal injury or ischemic optic neuropathy is suspected, urgent ophthalmologic consultation should be obtained.

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