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Alessandra Intili, Sina Vahedi, Murtaza K Adam, Faheem Ahmed, Brad Feldman, Tara Uhler; Consultations for Post-Operative Eye Pain Following Non-Ocular Surgery at a Tertiary Teaching Hospital. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5664.
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With a reported incidence of less than 1%, post-operative eye pain is associated with morbidity and accounts for 3% of all anesthesia-related malpractice claims. Exposure keratitis and corneal abrasions comprise 35% of these claims. Given associated symptom acuity and<br /> severity, anesthesia providers routinely seek urgent ophthalmology consults in such cases. Most corneal abrasions abrasions resolve within 24 to 48 hours; treatment consists of pain control and topical antibiotics to prevent microbial keratitis and scarring. Given its low incidence and straightforward treatment, some have questioned the necessity of urgent ophthalmology consults in these cases. We thus examined ophthalmic consultation findings for eye pain following non-ocular surgery at an academic tertiary medical center.
A retrospective review of Ophthalmology consults conducted at a tertiary hospital between January 1, 2006 and December 31, 2012 was performed; inpatient consults for evaluation of eye pain in the early (within 24 hours) post-operative period following nonocular surgery were identified and reviewed.
Two hundred and thirty four were requested to evaluate post-operative eye pain. An average of 33.4 such consults were requested per year. There was no significant increase in the frequency during the transition at the start of each academic year (P=0.805). Two hundred and twenty eight (97.4%, 95% CI 94.5-99.1%) patients were diagnosed with exposure keratitis or corneal abrasions. Six patients (2.6%, 95% CI 0.9-5.5%) were diagnosed with other conditions: two cases of acute angle closure glaucoma, two cases of suspected herpetic keratitis, one case of periocular contact dermatitis, and one case of chemical conjunctivitis.
The vast majority of consultations for post-operative eye pain were related to diagnoses of corneal abrasions or exposure keratitis. Although the incidence is rare, maintaining suspicion for visually threatening conditions like acute angle closure glaucoma is important to avoid potentially critical delays in diagnosis and treatment. Urgent inpatient ophthalmic consults for post-operative eye pain may thus be warranted. A future, prospective study should investigate the effects of educational interventions designed to address the causes, and therefore reduce the frequency, of post-operative eye pain.
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