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K. L. Segal, B. M. Levine, S. L. Faggiani, P. M. Fleischut, F. M. Gadalla, G. J. Lelli, Jr.; Evaluation and Future Directions of the Treatment of Perioperative Corneal Abrasions in a Major Tertiary Care Center. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5365.
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Background:Corneal abrasion is the most frequent eye injury seen perioperatively. Several independent risk factors have been identified, including: age, type of surgery, surgical positioning, and anesthesia modality. The cause of injury often remains unknown despite preventative measures. Time to diagnosis and time to treatment of perioperative corneal injury has not been evaluated.
To evaluate the time to diagnosis and treatment of perioperative corneal abrasions in a major tertiary care center and to propose an algorithm for improved care.
A retrospective review was conducted on patients diagnosed with a perioperative corneal abrasion between January 1, 2007 and December 31, 2008. Charts were culled for demographics, time to diagnosis, time to treatment and treatment recommended by a consulting ophthalmologist. Time to diagnosis was measured from the end of anesthesia administration to the first record of injury. Time to treatment was measured from the time of diagnosis to the time of prescribed ophthalmic medication.
Out of a total of 77,542 surgical procedures requiring anesthesia performed in 2007 and 2008, eighty-six (0.11%) perioperative corneal abrasions were diagnosed with a 94% consult rate by an ophthalmologist. The cohort consisted of 45% women and 55% men with an average age of 55 years (18-86). Average time to diagnosis was 129 minutes (0-518). Average time to treatment was 164 minutes (0-1008 ± 172). The most common treatment (37.6%) was antibiotic ointment combined with artificial tears. There were no long-term ophthalmic sequelae.
Corneal abrasions continue to occur in the perioperative setting. There is ample opportunity for improving time to diagnosis and treatment. We suggest the following algorithm that empowers Anesthesiology staff to make the diagnosis and begin treatment immediately following initial indication of eye injury (see Figure 1).
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