Comparison of eye protection with methylcellulose an paraffin ointments during general anaesthesia

Exploring Lacrimal Gland Tear Production in Sheep under General Anesthesia: Examining the Potential Impact of Utilizing 1% Hyaluronic Acid Ophthalmic Gel

The aim of the study is to assess the lacrimal gland tear production, using the Schirmer Tear Test (STT), in healthy sheep under general anesthesia and to explore the effects of applying 1% hyaluronic acid ophthalmic gel during general anesthesia. While STT values during anesthesia have been well documented in small animals such as cats and dogs, there seems to be a lack of information available for ruminants like sheep. This gap in the literature highlights the need for further research and exploration into tear production in sheep under anesthesia. The experimental research conducted on twelve adults female sheep provided valuable insights into tear production under anesthesia. By assessing tear production at various key time points the study was able to capture the changes in tear production throughout anesthesia and revealed a significant decrease in Schirmer Tear Test values in all sheep, following general anesthesia. The results showed that closing and taping the eye yielded determined better outcomes compared to administering a 1% lubricant ophthalmic gel. This finding suggests that eye care during anesthesia can impact tear production in sheep.

Ocular surface complications in children undergoing general anaesthesia: A prospective observational study

OBJECTIVE

Ophthalmic complications frequently occur after procedures requiring general anaesthesia, but their incidence is widely variable and not well reported in the paediatric population. The aim was to identify the incidence and possible risk factors of postoperative ocular surface complications in a tertiary care centre.

METHODS AND ANALYSIS

This is a prospective study for paediatric patients undergoing general anaesthesia. An ophthalmologist performed the ocular examination after surgery. Parameters assessed were tear breakup time, punctate epithelial erosions and corneal abrasions. Multivariate logistic regression model was used to assess risk factors.

RESULTS

A total of 108 paediatric patients were recruited, 36.1% showed abnormal corneal finding: 32 (29.6%) had decreased tear breakup time, three (2.7%) had punctate epithelial erosions, three (2.7%) had both punctate epithelial erosions and decreased tear breakup time and one (0.9%) was found to have a unilateral corneal abrasion postoperatively. A higher rate of corneal complications was noted with younger age, prolonged surgery and surgery in the head and neck region.

CONCLUSION

The rate of postoperative corneal abnormalities in children undergoing general anaesthesia was 36.1%, associated with younger age, prolonged surgery and surgery in the head and neck region.

Review, analysis, and education of antiseptic related ocular injury in the surgical settings

Preoperative skin antiseptic preparation is the gold standard for prevention of surgical infection. However, improper use of antiseptics may lead to severe ocular damage. Currently, the most common surgical antiseptics can be divided into aqueous-based and alcohol-based disinfectants, with chlorhexidine and iodine/iodophors being the two major components. Chlorhexidine has a persistent antimicrobial effect and is resistant to neutralization by blood or organic products in surgical wounds. Nevertheless, due to its toxicity to the ears, meninges, and eyes, application of chlorhexidine should be prohibited in these surgical fields. Iodine/iodophor is better tolerated by the ocular surface and is the recommended antiseptic for ophthalmic or head and neck surgeries close to the periocular area. Alcohol is less pricey and has a rapid antiseptic effect, though its desiccating effect and flammability restrict the use in mucosal or laser surgeries. The single or combined use of these antiseptics may inadvertently induce severe ocular damage, especially during time-consuming head and neck surgeries with prone, hyperextension, or lateral tilt positions, or surgeries under general anesthesia. Apart from the choice of antiseptics, appropriate selection and attachment of bio-occlusive dressings are key to avoiding antiseptic-related ocular injuries. In this review, we provided a comprehensive summary of the characteristics of antiseptics used in surgical settings and the possible mechanisms and outcomes of antiseptic-related ocular injuries. The prevention, diagnosis, and acute management of these complications were also discussed.

Diabetic keratopathy: Insights and challenges

Ocular complications from diabetes mellitus are common. Diabetic keratopathy, the most frequent clinical condition affecting the human cornea, is a potentially sight-threatening condition caused mostly by epithelial disturbances that are of clinical and research attention because of their severity. Diabetic keratopathy exhibits several clinical manifestations, including persistent corneal epithelial erosion, superficial punctate keratopathy, delayed epithelial regeneration, and decreased corneal sensitivity, that may lead to compromised visual acuity or permanent vision loss. The limited amount of clinical studies makes it difficult to fully understand the pathobiology of diabetic keratopathy. Effective therapeutic approaches are elusive. We summarize the clinical manifestations of diabetic keratopathy and discuss available treatments and up-to-date research studies in an attempt to provide a thorough overview of the disorder.

Iatrogenic Damage of Eye Tissues: Current Problems and Possible Solutions

Visual system is at high risk of iatrogenic damage. Laser ocular surgery, the use of powerful illumination devices in diagnostics and surgical treatment of eye diseases, as well as long surgeries under general anesthesia provoke the development of chronic degenerative changes in eye tissues, primarily in the cornea and the retina. Despite the existence of approaches for prevention and treatment of these complications, the efficacy of these approaches is often limited. Here, we review the mechanisms of iatrogenic damage to eye tissues at the cellular and biochemical levels. It is well recognized that oxidative stress is one of the main factors hindering regeneration of eye tissues after injuries and, thereby, aggravating iatrogenic eye disorders. It is accompanied by the downregulation of low-molecular-weight antioxidants and antioxidant enzymes, as well as changes in the expression and redox status of proteins in the damaged tissue. In this regard, antioxidant therapy, in particular, the use of highly effective mitochondria-targeted antioxidants such as SkQ1, is considered as a promising approach to the prevention of iatrogenesis. Recent findings indicate that the most efficient protection of eye tissues from the iatrogenic injury is achieved by preventive use of these antioxidants. In addition to preventing corneal and retinal cell death induced by oxidative stress, SkQ1 contributes to the restoration of innate antioxidant defense of these tissues and suppresses local inflammatory response. Since the timing of routine medical manipulations is usually known in advance, iatrogenic damage to the ocular tissues can be successfully prevented using mitochondria-targeted therapy.

Effectiveness of corneal abrasion prevention interventions for adults undergoing general anesthesia for more than one hour: a systematic review protocol

REVIEW QUESTION

The question of this review is: what is the effectiveness of eye lubrication, tape and/or a combination of these interventions in preventing corneal abrasions in adult patients aged 18 and over undergoing general anesthesia for more than one hour?

Perioperative Corneal Abrasion: Updated Guidelines for Prevention and Management

Corneal abrasion is the most common ocular complication in surgery. Treatment requires pain control, antimicrobial prophylaxis, and close monitoring. Pain improves significantly after 24 hours and should be resolved by 48 hours. Persistent, worsening, or new symptoms warrant immediate specialist consultation. The authors review the pathophysiology of perioperative corneal abrasion, and propose updated evidence-based guidelines for improved patient care.

Postanaesthetic tear production and ocular irritation in cats

OBJECTIVE

General anaesthesia significantly reduces tear production and normal values are not immediately re-established on ending anaesthesia. Therefore, adequate protection of the cornea has to be assured during the perianaesthetic period. There are various methods available, including taping of the eyelids and the application of eye ointments, gels and drops. In human medicine studies, different formulations were found to induce signs of ocular irritation. The aim of the present study was to determine tear production in cats after general anaesthesia, and to identify possible causes of irritation.

MATERIAL AND METHODS

Tear production was determined in 41 cats after general anaesthesia and eyes were examined for signs of irritation. Two different anaesthetic protocols were used. To protect the cornea, an ointment and gel were applied to the right and left eyes, respectively.

RESULTS

Postoperatively, tear production was significantly reduced for 6 hours and 18 hours in the right and left eyes, respectively. Two hours after anaesthesia, blepharospasm of the right eye was observed in 92.7% (n = 38) of the cats. In contrast, the left eye was always held open.

CONCLUSIONS

This study demonstrated that tear production in cats is significantly decreased both during and after anaesthesia. The degree of reduction was independent of the anaesthetic protocol. Both the eye ointment and gel proved effective in protecting the corneal surface. However, eye gel use is recommended because the eye ointment consistently caused an irritation comparable to the foreign-body sensation reported in humans.

Corneal protection during general anesthesia for nonocular surgery

Corneal abrasion is the most common ophthalmologic complication that occurs during general anesthesia for nonocular surgery. Such abrasions can be caused by a variety of mechanisms and can lead to sight-threatening microbial keratitis and permanent scarring. There is no standard mode of protecting the cornea during general anesthesia for nonocular surgery. Methods described in the literature are not entirely effective and may be associated with unwanted side effects. Taping alone provides protection that is equivalent or superior to other interventions and has fewer side effects. Petroleum gel is flammable and is best avoided when electrocautery and open oxygen are to be used around the face. Preservative-free eye ointment is preferred, as preservative can cause corneal epithelial sloughing and conjunctival hyperemia. Recently, the application of Geliperm and bio-occlusive dressings has been advocated. Geliperm may be particularly useful during endonasal surgery when continuous perioperative observation of the eye is required. In this article, the literature on the etiology of perioperative corneal abrasions is reviewed and various protection strategies are compared in order to identify the best methods to prevent corneal abrasions during general anesthesia.

Detection and Treatment of Perioperative Corneal Abrasions

Corneal abrasion is the most common ocular injury occurring in the perioperative period. Corneal abrasion may occur during general anesthesia, monitored anesthesia care, regional anesthesia, or in the immediate recovery period. This injury is not usually apparent until the patient is in the PACU, and the perianesthesia nurse may be the first clinician to detect this complication. Preventive measures and vigilant care can help reduce the incidence of corneal abrasion in susceptible patients. Early detection and prompt intervention may help reduce the incidence of ocular morbidity. The purpose of this article is to explore the incidence, mechanism of injury, prevention, recognition, and treatment of perioperative corneal abrasion.

Clear hydro-gel, compared to ointment, provides improved eye comfort after brief surgery

PURPOSE

Anesthesia impairs lid closure and decreases tear secretion and stability. Protection may, in principle, be conveyed by manual eye closure, taping the eyelids closed, and by instillation of protective substances into the conjunctival sac. Both hydro-gels and ointments are used in clinical practice. It was the objective of the present study to compare a transparent clear ocular hydro-gel (Vidisic) and a commonly used dexpanthenol and vitamin A (Oleovit) based ointment as examples of these classes of ocular lubricants in their capability to provide perioperative eye comfort. Furthermore, their bacteriostatic properties were assessed in vitro.

METHODS

Ninety-two consecutive patients undergoing total iv general anesthesia were randomly allocated to receive either ocular dexpanthenol ointment or a clear hydro-gel after induction of anesthesia. Subjects were assessed one hour following termination of anesthesia.

RESULTS

Main findings were an increased incidence of foreign body sensation, adherent eyelashes and disturbance elicited by blurred vision in the ointment group as compared to clear hydro-gel (P < 0.001). Bacterial growth was significantly attenuated by the ocular hydro-gel as compared to ointment.

DISCUSSION

Clear ocular hydro-gel offers improved patient comfort and decreased ocular inflammation as compared to conventional eye ointments. In addition, it decreases bacterial growth. Therefore, the use of clear ocular hydro-gel for perioperative ocular comfort is suggested.

Comparison of methods of eye protection under general anaesthesia

PURPOSE

To compare and assess the efficacy of eye ointment and adhesive tape for protection of eyes under general anaesthesia.

METHODS

One hundred and fifty patients (300 eyes) undergoing general anaesthesia for > 90 min for non-ophthalmic procedures were divided randomly into three groups (C, T & O). Eyes in group C were left as control, in group T hypoallergen tape was applied and in group O chloromycetin ointment was used. In all eyes basal tear production and visual acuity was assessed and corneal examination was carried out after fluorescein staining both before and after surgery. All the patients were subjected to a conventional general anaesthesia technique.

RESULTS

General anaesthesia reduced basal tear production irrespective of the method of eye protection used (P < 0.0001). The overall incidence of corneal epithelial defects was 10%, of which 90% occurred in the control group, 6.6% in the tape and 3.3% in the ointment group. There was no difference between pre and post operative visual acuity (P : NS). Corneal injuries were more common in the dependent eye in the lateral position and the incidence of corneal epithelial defects did not alter with increase in duration of surgery.

CONCLUSION

During general anaesthesia eyes need protection either by tape or ointment as incidence of corneal injuries is greater in unprotected eyes.

The aetiology and prevention of peri-operative corneal abrasions

Corneal abrasion is the most frequent ocular complication to occur during the peri-operative period. This review describes the aetiology of corneal abrasions and evaluates the current methods of prevention. Most abrasions are caused by lagophthalmos (failure of the eyelids to close fully) during general anaesthesia, resulting in corneal drying. General anaesthesia reduces both the production and the stability of tears and therefore increases the incidence of this painful condition. Taping the eyelids closed, soft contact lenses, the instillation of aqueous gels or paraffin-based ointments are all effective in preventing corneal abrasions, but ointments are associated with significant morbidity.