• The secretion of tears is reduced under general anaesthesia, leading to relatively dry eyes which may become adherent to the inner surface of the eyelid.

• The reopening of the eye causes shearing forces, which may result in corneal abrasion (CA). These are usually minor and asymptomatic.

• The pain associated with CA may be significant and the key management concerns are pain control and prevention of infection. Healing usually occurs within 3-4 days, at which point pain will usually subside.

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Abbreviations

The secretion of tears is reduced under general anaesthesia, leading to relatively dry eyes which may become adherent to the inner surface of the eyelid.

The reopening of the eye causes shearing forces, which may result in corneal abrasion (CA). These are usually minor and asymptomatic.

The incidence of symptomatic CA after general anaesthesia is approximately 1/2800¹, whilst the incidence of a small asymptomatic CA following standard eye care under anaesthesia may be as high as 1/25.

The pain associated with CA may be significant and the key management concerns are pain control and prevention of infection. Healing usually occurs within 3-4 days, at which point pain will usually subside.

Ensure the eye is fully closed when taping shut; place the tape on the upper eyelid and check that as you pull the tape down the eyelids touch, not overlap, and the eye closes fully.

In known dry eye patients, consider a lubricant gel first, e.g., carbomer gel.

If, however, they are immunosuppressed or an ICU patient, simple eye ointment or Xailin ® Night can be used instead (patient will need reassuring that vision will be blurry until the ointment blinks away a few hours after waking). This may make the tape harder to stick but is important to consider in long cases.

1. Analgesia – multimodal systemic analgesia and proxymetacaine 0.5% eye drops Q2 hrs

2. Infection prevention – chloramphenicol ointment 1%  Q4hrs

3. Referral as below

4. Report via Trust Incicent Reporting System

Where there are no worrying features the patient will ordinarily be made an appointment to be seen the next day in the emergency clinic.

Wexham

During daytime hours: discuss the case with on call team at Eye Casualty at King Edward VII Hospital, Windsor, on 01753 636359 or via switchboard.

Out of hours: discuss case with non-resident on call Ophthalmologist based at Frimley Park Hospital via switchboard.

Frimley

During daytime hours (Mon-Fri 9am-5pm):

• Inpatient: discuss the case with the ophthalmic nurse in the Frimley Emergency Clinic on 03006 136854. Alternatively refer via Epic.

• Outpatient: Refer via Epic or ask the patient to attend walk in eye casualty at Prince Charles Eye Unit, King Edward VII Hospital, Windsor.

Out of hours: discuss the case with non-resident on call Ophthalmologist based at Frimley Park Hospital via switchboard.

1. Roth S et al. (1996) 'Eye Injuries after Nonocular Surgery: A Study of 60,965 Anaesthetics from 1988 to 1992', Anesthesiology 85(5): 1020-1027. Available at: https://doi.org/10.1097/00000542-199611000-00009

2. White E and Crosse MM (1988) 'The aetiology and prevention of peri-operative corneal abrasions', Anaesthesia 53(2): 157-161. Available at: https://doi.org/10.1046/j.1365-2044.1998.00269.x

This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date. This guideline is for use in Frimley Health Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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