Abstract
Purpose: :
To determine whether education of anesthesiologists in methods of corneal protection can reduce the rate of peri-operative corneal abrasions.
Methods: :
A prospective study was performed to identify all cases of peri-operative corneal abrasion during non-ophthalmologic surgeries occurring during the time period from July 2009 to October 2010 at NYU Langone Medical Center in New York, NY. During the midpoint of the observation period the Anesthesiology department was informed via written memorandum in proper methods of lid taping, intra-operative usage of eye ointment, optimal placement of pulse oximeter probes, and proper methods of tape removal.
Results: :
We identified a total of 45 peri-operative corneal abrasions in the 16-month observation period, which corresponds to an overall incidence of 0.122%. The educational initiative resulted in a small, non-significant reduction in the incidence of peri-operative corneal abrasions from 0.127% before education to 0.118% after education (odds ratio= 0.926, 95% confidence interval= 0.516-1.662). All cases were identified by the primary team on the day of surgery or the first post-operative day, resulting in Ophthalmology consultation and treatment with antibiotic eyedrops or ointment.
Conclusions: :
At our institution, education of anesthesiologists in proper methods of corneal protection produced a minimal reduction in the incidence of peri-operative corneal abrasion. However, it is important to note that measures of incidence may have been confounded by the fact that the study itself encouraged recognition of corneal abrasions, which may have led to increased reporting of this complication in the post-education period. Overall, the results of our research suggest that many abrasions may not result from clinician error, but from the inherent risks associated with general anesthesia such as lagophthalmos, decreased tear production, and abolishment of Bell’s phenomenon. Increasing awareness of peri-operative corneal abrasion in non-ophthalmologic practitioners can aid in reducing the morbidity of this condition by encouraging earlier identification and treatment.
Keywords: cornea: clinical science • cornea: epithelium • clinical (human) or epidemiologic studies: prevalence/incidence