Risk Assessment and Prevention of Corneal Complications After Lateral Skull Base Surgery

Effect of polyethylene cover on the treatment of exposure keratopathy in ICU

BACKGROUND

Exposure keratopathy may lead to serious complications such as microbial keratitis, corneal perforation, and visual impairment if not treated.

AIM

To compare the effect of carbomer eye drops when used alone and in combination with polyethylene covers in the healing of exposure keratopathy.

METHODS

A single blind randomized-controlled trial (RCT) in two intensive care units (ICUs) was carried out in a university hospital in Western Turkey between September 2011 and December 2012. The control group received only carbomer, eye drops while the intervention group received both carbomer eye drops and polyethylene covers. The primary outcome was the decrease or absence of corneal damage, which refers to healing. Corneal damage was followed up with a fluorescein dye test (decrease/absence of the corneal staining) by the same ophthalmologist for 10 days.

RESULTS

A total of 43 corneas in 24 patients were studied. Corneal epithelial defects decreased in the intervention group by day 2 and progressed or remained unchanged in the control group every day (P = .001). Patient characteristics did not affect the grade ranges of corneal staining in the groups except for level of consciousness.

CONCLUSION

Carbomer eye drops, when used in combination with polyethylene covers, were effective in managing exposure keratopathy.

RELEVANCE TO CLINICAL PRACTICE

Corneal damage and further ocular complications can be reduced with the utilization of polyethylene covers in nursing care and treatment.

Ophthalmic and orbital considerations in the evaluation of skull base malignancies

INTRODUCTION

The orbital contents, afferent and efferent visual pathways, and the cranial nerves involved in eye movement, corneal sensation and eyelid closure traverse the skull base, a region bounded by the intracranial cavity, the paranasal sinuses, and the deep spaces of the face and head. As such, tumors from above or below have potential to affect some aspect of the visual system.

METHODS

We discuss here the clinical ophthalmologic and orbital considerations in the evaluation of patients with these tumors, as well as the ophthalmic sequelae of treatment with radiation or surgery (or both). And for the surgeon, we discuss the ophthalmic and orbital considerations in surgical planning, the role of the orbital surgeon in skull base surgery, and briefly discuss transorbital approaches to the skull base.

RESULTS AND CONCLUSION

Ophthalmic and orbital dysfunction may be the main source of disability in patients with skull base malignancy; it is thus incumbent on those who manage patients with tumors of this region to be aware of the ophthalmic, neuro-ophthalmic and orbital manifestations, so as to best tailor therapy and monitor treatment outcomes.