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Corneal Abrasions

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Background​

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  • Definition: Injury to the epithelial layer of the cornea (4-6 cell layers thick); the outermost layer of the globe of the eye

    • Cornea is avascular and very densely innervated

    • Most common ocular complication in surgery (0.01-0.1% incidence)

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Considerations​

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  • Signs/symptoms: pain, tearing, blurry vision, photophobia

  • Risk factors:

    • General anesthesia

    • Hx of dry eyes

    • Advanced age

    • Proptosis or exorbitism

    • Hx of corneal trauma

    • Longer procedures >60 mins

    • Pre-op anemia

    • Prone, lateral or Trendelenburg position

    • Procedures near head/neck

    • Intra-op hypotension

  • Potential Sources (true cause is often unknown):

    • After induction:

      • laryngoscope, face mask, watch, ID badge

    • Before incision:

      • surgical prep, gauze/sponges, surgical drapes

    • During procedure:

      • instruments, chemical solutions, heat sources, globe pressure, eye shields

    • Extubation:

      • O2 mask, patient fingers

  • Diagnosis:

    • Ophthalmology consult for slit lamp exam to rule out more serious injury (i.e. penetrating injury)

    • Corneal abrasion dx confirmed with fluorescein exam of the ocular surface under blue light

 

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Prevention​

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  • Staff education about eye care

  • Secure eye lids in closed position after induction

    • Use Tegaderm/OpSite > tape in high risk patients

  • Use of preservative-free ocular lubricants

 

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Management

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  • Corneas heal on their own without scar formation within 72 hrs

  • Goal is to minimize pain & prevent infection

    • Pain typically improves within 24-48 hrs

    • If not improving, need to rule out infection / missed dx

  • Pain management:

    • Oral NSAIDs PRN

    • Preservative-free 0.5% methylcellulose lubricant drops PRN

    • Topical anesthetics (e.g. 1% tetracaine HCl)

    • Persistent pain >24-48 hrs should warrant ophthalmology

  • Infection prevention:

    • topical antibiotics x 2-3 days (e.g. Erythromycin 0.5% ointment)

  • Avoid:

    • eye patches

    • topical NSAIDs

    • topical steroids

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References​

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  • Malafa MM, Coleman JE, Bowman RW, Rohrich RJ. Perioperative Corneal Abrasion: Updated Guidelines for Prevention and Management. Plast Reconstr Surg. 2016 May;137(5):790e-798e. doi: 10.1097/PRS.0000000000002108. PMID: 27119941.

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