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Kubba R, Kandavel GR, Scott J, Roldan C, Jackson H. Bandage contact lens for in-game corneal abrasion can allow immediate return to play. Front Sports Act Living 2024; 6:1351906. [PMID: 38500545 PMCID: PMC10944872 DOI: 10.3389/fspor.2024.1351906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
While the prevailing treatment for corneal abrasions outside the athletic sphere is the application of a bandage contact lens (BCL), which lessens pain and allows for the maintenance of binocular vision, this is not the case during athletic play. This brief report highlights the advantage of BCLs in treating in-game corneal abrasions, ultimately allowing for an immediate return to play. Additionally, this report summarizes the mechanisms of bandage contact lenses, differentiates them from standard hydrogel contact lenses, and highlights the significant steps necessary to apply the bandage contact lens during an in-game corneal abrasion event. Overall, we link modern ophthalmology clinical practice and sports medicine, allowing for the attenuation of acutely-induced ocular pain to a manageable state.
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Affiliation(s)
- Rohan Kubba
- Department of Ecology and Evolutionary Biology, University of California Los Angeles, Los Angeles, CA, United States
| | - Ganesha R. Kandavel
- Surgical and Medical Ophthalmology, Colvard-Kandavel Eye Center, Encino, CA, United States
- Department of Sports Medicine, Los Angeles Galaxy Soccer, Carson, CA, United States
- Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Joshua Scott
- Department of Sports Medicine, Los Angeles Galaxy Soccer, Carson, CA, United States
- Department of Orthopaedics and Sports Medicine, Cedars Sinai Medical Center Kerlan-Jobe Institute, Tarzana, CA, United States
| | - Cesar Roldan
- Department of Sports Medicine, Los Angeles Galaxy Soccer, Carson, CA, United States
| | - Hayden Jackson
- Department of Ecology and Evolutionary Biology, University of California Los Angeles, Los Angeles, CA, United States
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2
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Liyew TM, Mersha AT, Admassie BM, Arefayne NR. Risk stratification, prevention and management of perioperative corneal abrasion for non-ocular surgery: Systematic Review. Ann Med Surg (Lond) 2024; 86:373-381. [PMID: 38222698 PMCID: PMC10783396 DOI: 10.1097/ms9.0000000000001566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024] Open
Abstract
Background A corneal abrasion is a flaw in the cornea's epithelial surface, which is located in the front of the eye. It causes recurrent erosions, corneal inflammation, and chronic corneal defects. In a context with limited resources, the goal of this review was to provide an evidence-based procedure for perioperative risk stratification, prevention, and management of corneal abrasion during non-ocular surgery. Methods A medical search engines of PUBMED, GOOGLE SCHOLAR, COCHRANE REVIEW, and PUBMED CENTERAL to get access for current and updated evidence on procedures on risk stratification, prevention and management of corneal abrasion for non-ocular surgery. The authors formulate the key questions, scope, and articles written in English language, human study focuses on corneal abrasion, articles in the last 20 year was implemented to identify or filter high-level evidences were included. Reports contain corneal abrasion due to ocular surgery were excluded. All the research articles, which were identified from searches of electronic databases, were imported into Endnote software, duplicate were removed advanced search strategy of electronic sources from databases and websites was conducted using Boolean operators (cornea AND (abrasion OR injury OR laceration)) AND ("Perioperative Period" OR "general anesthesia"). Screening of literatures was conducted with proper appraisal checklist. This review was reported in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement. Results From 8767 identified articles, two hundred articles were removed for duplication and 7720 studies were excluded, 1205 articles were retrieved and evaluated for eligibility. Finally, 24 were included in this systematic review. Advanced age, Prominent eyes, exophthalmus, ocular surface abnormalities (dry eye), expected duration of surgery (>1 h), the favourable position of the surgery, prone,Trendelenburg and lateral, risk of bleeding, surgical site of the surgery(head /neck) and diabetes mellitus were risk for corneal abrasion. The use of appropriate intervention with pharmacological and Non-pharmacological strategies minimizes the occurrence of perioperative corneal abrasion was crucial for the quality of care. Conclusion Preventing and managing corneal abrasion improves patients' quality of life. However, there was insufficient evidence to draw conclusions, and high-quality trials of multimodal interventions matched to risk stratification and prevention of corneal abrasion needed to provide robust evidence to guide prevention and management of perioperative corneal abrasion.
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Affiliation(s)
| | | | - Belete Muluadam Admassie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
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3
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Safari S, McLaughlin CJ, Shah A, Kane BG. Prolonged Ocular Foreign Body Found on Repeat Visit to a Second Emergency Department. Cureus 2023; 15:e37819. [PMID: 37214081 PMCID: PMC10197908 DOI: 10.7759/cureus.37819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
We describe a case where the patient presented to the emergency department (ED) with ocular irritation in the right eye with concomitant blurry vision that had been persistent for a week. The cause of this patient's ocular irritation and worsening visual acuity was determined to be a retained foreign body of the limbus. The foreign body had been in the patient's eye for about four months before he began to experience these symptoms. The four-month duration was established based on initial symptoms and a prior ED visit with no noted eye injury or foreign body detection, as well as the degree of overlying epithelization. This case highlights the importance of obtaining a thorough history and physical examination while emphasizing the high index of suspicion needed for translucent foreign bodies. Here, an inert foreign body erupted four months after injury. Additionally, this case stresses the importance of transition of care for ophthalmologic conditions. Consideration of any social determinants of health that could prevent as an example.
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Affiliation(s)
- Sara Safari
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Conor J McLaughlin
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Avani Shah
- Department of Surgery, Division of Ophthalmology, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Bryan G Kane
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
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Alsarhani WK, Almater AI, Alkharashi MS. Leptospermum Medical Grade Manuka Honey Ointment in the Treatment of Persistent Corneal Epithelial Defect. Ocul Immunol Inflamm 2022:1-4. [PMID: 35522271 DOI: 10.1080/09273948.2022.2070505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To study the efficacy of 100% Leptospermum medical grade Manuka honey ointment in persistent corneal epithelial defects (CEDs). METHODS Case series. RESULTS Case 1 was a 25-year-old female patient who presented to the cornea clinic with a persistent CED (3.5 mm), following acanthamoeba keratitis, that had failed to respond to heavy, frequent lubrication drops and ointment. Two weeks later, after starting Leptospermum honey ointment (4 times per day), the CED healed totally. Case 2 was a 48-year diabatic, single-eyed female patient who presented with a persistent CED (1.5 × 1.5 mm) that had failed to respond to heavy, frequent lubrication drops and ointment. The CED healed three weeks after starting Leptospermum honey ointment (4 times per day). CONCLUSIONS Leptospermum honey ointment can be a potential treatment for persistent epithelial defect.
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Affiliation(s)
- Waleed K Alsarhani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Department of Ophthalmology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Porter SB, Chamorro-Pareja N, Boles KS, Rodgers IL, Rodrigues ES. A Quality Improvement Project to Decrease Perioperative and Periprocedural Corneal Abrasions. J Perianesth Nurs 2022; 37:317-320. [PMID: 35246365 DOI: 10.1016/j.jopan.2021.06.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/21/2021] [Accepted: 06/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We assessed our institution's rate of perioperative and periprocedural corneal abrasions (CAs) and implemented a quality improvement project to improve our detection of CAs and decrease their incidence by at least 25% over 12 months. DESIGN Retrospective review before and after initiation of a quality improvement project at a single tertiary care institution METHODS: We retrospectively reviewed surgical and procedural patients requiring any type of anesthesia care over three 1-year time periods (2014-2015, 2016-2017, and 2017-2018). Using an electronic pharmacy-based query to identify patients who received proparacaine eye drops in the recovery room, we were able to estimate our incidence of CA during these time periods. We implemented a best practice plan to standardize CA prevention, diagnosis, and treatment after determining our baseline incidence of CA. FINDINGS Our baseline incidence rate of perioperative and periprocedural CAs was 0.22% (43/19,790 anesthetics) in the 2014-2015 time period. In the 2016-2017 and 2017-2018 time periods, the incidence rate was reduced to 0.09% (21/23,652 anesthetics) and 0.1% (23/23,825 anesthetics), respectively. The use of a standardized CA prevention, diagnosis, and treatment plan reduced the relative risk of CAs by 59% in 2016-2017 (P < .001) and 56% in 2017-2018 (P = .001) compared to baseline, with an absolute reduction of 13% and 12% over those time periods. CONCLUSION Our data suggests that the adoption of a simple, standardized perioperative and periprocedural CA prevention, diagnosis, and treatment plan can result in sustained reductions in the occurrence of perioperative CAs.
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Affiliation(s)
- Steven B Porter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL.
| | - Natalia Chamorro-Pareja
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL; Jacobi Medical Center, Bronx, NY
| | - Kathryn S Boles
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology, Naples Community Hospital, Naples, FL
| | - Ingrid L Rodgers
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Eduardo S Rodrigues
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
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Young ME, Mears SC, Sallam AB, Sanders RN, Barnes CL, Stambough JB. Corneal Abrasions in Total Joint Arthroplasty. Geriatr Orthop Surg Rehabil 2021; 12:21514593211060101. [PMID: 34868725 PMCID: PMC8641105 DOI: 10.1177/21514593211060101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Corneal abrasion (CA) is the most common ocular complication in patients undergoing nonocular surgery. Corneal abrasions can be caused by a variety of mechanisms, the most common being drying of the cornea due to reduced tear secretions, loss of eyelid reflex, and the loss of pain recognition during surgery. Though CA heals well with eye lubricants, it can result in significant ocular pain and some cases may go on to develop ocular complications. With the current switch to outpatient total joint replacement, CA could potentially lead to discharge delays. Materials and Methods We examined the results of a quality improvement project to reduce CA during general anesthesia to determine the rates of CA during hip and knee total joint replacement. We compared rates of CA for 6 months before and 6 months after the intervention. Results A total of 670 hip and knee arthroplasty procedures were performed during this period. Two events of CA occurred, one occurred before and one after the intervention to decrease eye injuries. Both incidences occurred during total hip arthroplasty (THA) procedures with the patient in the lateral decubitus position and recovered without long-term deficit. Discussion Surgeons and anesthesiologists alike should be cognizant of this avoidable complication and take precaution to protect the eyes during surgery, especially during THA when the patient is placed in the lateral decubitus position. Conclusion Corneal abrasion during total joint arthroplasty is a rare complication and is infrequently addressed in the literature. CA is mostly self-limiting, however, but may lead to patient dissatisfaction and to delays if same-day discharge is attempted. Preventative measures and attentive care may help reduce the incidence of CA in patients undergoing total joint arthroplasty. The lateral decubitus position and longer surgeries times are risk factors for CA.
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Affiliation(s)
- Megan E Young
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed B Sallam
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Riley N Sanders
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Parameswaran A, Panneerselvam E, Jayakumar N. The Conjunctival Turnover: A Simple and Effective Method for Sclero-Corneal Protection in Pre-Septal Transconjunctival Approach to the Orbital Floor. Cureus 2021; 13:e18884. [PMID: 34804731 PMCID: PMC8599114 DOI: 10.7759/cureus.18884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/01/2022] Open
Abstract
Transconjunctival approaches have become the mainstay for most surgeons performing orbital wall reconstructions. Adequate care needs to be exercised for the protection of the cornea and sclera during these surgeries as they may involve placement of grafts or implants in situ apart from the routine intra-orbital dissections. The authors describe a simple technique of developing a conjunctival turnover flap for sclero-corneal protection in transconjunctival approaches to the orbit.
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Affiliation(s)
| | - Elavenil Panneerselvam
- Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Chennai, IND
| | - Naveenkumar Jayakumar
- Oral and Maxillofacial Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, IND
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8
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Badparva M, Veshagh M, Khosravi F, Mardani A, Ebrahimi H. Effectiveness of lubratex and vitamin A on ocular surface disorders in ICU patients: A randomized clinical trial. J Intensive Care Soc 2020; 22:136-142. [PMID: 34025753 DOI: 10.1177/1751143720912697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background High prevalence of ocular surface disorders includes eye dryness and corneal ulcer among intensive care unit patients remains an issue. This study aimed to compare the effectiveness of Lubratex ointment and vitamin A eye ointment in preventing ocular surface disorders in intensive care unit patients. Methods A single-center randomized clinical trial was conducted in critically ill patients of vitamin A eye ointment and Lubratex ointment in preventing ocular surface disorders. Forty-one eligible patients were randomly assigned to administered vitamin A eye ointment in one eye and Lubratex ointment in the other eye. After five days, using fluorescein and Schirmer's tests, an ophthalmologist examined patients and specified those with ocular surface disorders. Results The results showed a significant decrease in the incidence of dry eye (p ≤ 0.001) and corneal ulcer (p = 0.002) with the use of Lubratex ointment. Conclusions Although Lubratex ointment was more effective than vitamin A ointment in preventing ocular surface disorders, further research is needed to confirm the findings of the present study.
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Affiliation(s)
- Mitra Badparva
- Student Research Committee, School of Nursing & Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Veshagh
- Imam Hossein Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Farideh Khosravi
- Environmental and Occupational Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Abbas Mardani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ebrahimi
- Randomized Controlled Trial Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
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Abstract
Purpose To comprehensively review the literature regarding recurrent corneal erosion (RCE) and to present treatment options and recommendations for management. Overview RCE usually presents with sharp, unilateral pain upon awakening, in an eye with an underlying basement membrane dystrophy, prior ocular trauma, stromal dystrophy or degeneration, or prior surgery for refractive errors, cataracts, or corneal transplantation. Making the correct diagnosis requires a careful slit-lamp examination of both eyes coupled with a high degree of suspicion. Several treatments are commonly used for RCE but new therapies have been introduced recently. Conservative treatment consists of antibiotic and preservative-free lubricating drops, with topical cycloplegics and oral analgesics to control pain. Patients who are unresponsive to these therapies may benefit from therapeutic bandage contact lenses (BCL). Newer therapies include oral matrix metalloproteinase (MMP) inhibitors, blood-derived eye drops, amniotic membrane graft application, and judicious application of topical corticosteroids. Once the epithelium is healed, a course of hypertonic saline solution and/or ointment can be used. Surgical procedures may be performed in patients who fail conservative therapy. Punctal occlusion with plugs increases the tear film volume. Epithelial debridement with diamond burr polishing (DBP), anterior stromal puncture (ASP), or alcohol delamination should be considered in selected patients. DBP can be used for patients with basement membrane dystrophies and is the preferred treatment overall due to a low recurrence rate. ASP can be used for erosions outside the central visual axis. Excimer laser phototherapeutic keratectomy is an attractive option in eyes with central RCE since it precisely removes tissue while preserving corneal transparency. In patients with RCE who are also candidates for refractive surgery, photorefractive keratectomy can be considered. Summary Newly introduced therapies for RCE enable therapy to be individualized and lower the recurrence rate.
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Affiliation(s)
- Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
| | - Syed A Hasan
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
| | - Nathaniel L Simmons
- Department of Ophthalmology, University of Rochester, Rochester, NY 14642, USA
| | - Michael W Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
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Ramappa M, Dhakal R, Chaurasia S. Oval sign: A retained bee stinger. Indian J Ophthalmol 2018; 66:1466-1467. [PMID: 30249836 PMCID: PMC6173003 DOI: 10.4103/ijo.ijo_465_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Muralidhar Ramappa
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Roheet Dhakal
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sunita Chaurasia
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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11
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Marsden J, Davies R. How to care for a patient's eyes in critical care settings. Nurs Stand 2018; 31:42-45. [PMID: 28097921 DOI: 10.7748/ns.2016.e10571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rationale and key points Eye care is an important aspect of the nursing management of patients who are critically ill. All patients in acute care settings with absent or compromised eye defence mechanisms are at risk of eye complications and ocular surface disease. This article aims to assist nurses to care for the eyes of patients in critical care settings to enable early detection and routine management of ophthalmic issues, thereby avoiding visual compromise on patient discharge from critical care settings. » Corneal exposure is reported to occur in many patients who are critically ill. » Incomplete eyelid closure and lack of lubrication are the main mechanisms that underlie the development of corneal damage in patients who are critically ill. » Unconscious, sedated and/or paralysed patients and those with a reduced Glasgow Coma Scale score depend on healthcare professionals to maintain their ocular surface to prevent complications such as corneal abrasion, infection and ulceration, perforations and blindness. » Meticulous nursing care is required to prevent ophthalmic complications that can result from corneal exposure in this patient group. Regular, evidence-based eye care should be part of routine nursing practice for patients who are critically ill. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice? 2. How you could use this resource to educate your colleagues in eye care of the unconscious patient?
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Affiliation(s)
- Janet Marsden
- Manchester Metropolitan University, Manchester, England
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12
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Ní Mhéalóid Á, Lukasik T, Power W, Murphy CC. Alcohol delamination of the corneal epithelium for recurrent corneal erosion syndrome. Int J Ophthalmol 2018; 11:1129-1131. [PMID: 30046528 DOI: 10.18240/ijo.2018.07.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/16/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the outcomes of alcohol delamination (ALD) of the corneal epithelium for the treatment of recurrent corneal erosion syndrome (RCES) and to implement a standardized treatment protocol for this condition utilizing evidence based practice and the findings of an internal audit. METHODS A retrospective analysis of 42 eyes of 40 patients diagnosed with RCES who were treated with ALD between January 2006 and March 2016 was conducted. Patients had 20% alcohol applied to the cornea with the use of a well for 40s. Patients were reviewed one week later in the Outpatient Department. Outcome criteria were established based on standards from other studies in the medical literature. These included, a treatment success rate of at least 72% (defined as complete resolution of symptoms one month after treatment), a postoperative complication a rate of <5% (mainly infective keratitis, and subepithelial haze), and the absence of any detrimental effect on visual acuity in ≥95% of patients. RESULTS The mean age at the time of ALD was 41.17±13.44y. Patients were followed for an average of 12.8±15.65mo. The majority were female (52.5%, n=21) and the majority of eyes treated with ALD were left eyes (62.9%, n=26). Trauma was the primary aetiology in our study population. Treatment was successful in 73.8% (n=31) of eyes and in 75% (n=30) of patients. Recurrence occurred in 26.2% of eyes at a mean of 10.41±12.63mo post treatment. CONCLUSION ALD is an efficacious and cost-effective primary surgical intervention for RCES.
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Affiliation(s)
- Áine Ní Mhéalóid
- Education and Research Centre, Royal Victoria Eye and Ear Hospital, Dublin D02XK51, Ireland
| | - Taylor Lukasik
- School of Medicine, RCSI School of Medicine, Dublin D02VN51, Ireland
| | - William Power
- Ophthalmology Department, Royal Victoria Eye and Ear Hospital, Dublin D02XK51, Ireland
| | - Conor C Murphy
- Education and Research Centre, Royal Victoria Eye and Ear Hospital, Dublin D02XK51, Ireland
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13
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Scarabelli S, Timofte D, Malalana F, Bardell D. Corneal abrasion and microbial contamination in horses following general anaesthesia for non-ocular surgery. Vet Anaesth Analg 2018; 45:278-284. [PMID: 29409802 DOI: 10.1016/j.vaa.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/15/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the incidence of corneal abrasions/ulceration and microbial contamination in horses undergoing general anaesthesia. STUDY DESIGN Prospective, observational, clinical study. ANIMALS A total of 40 client-owned healthy horses scheduled for elective non-ophthalmic procedures. METHODS Conjunctival sac swabs were taken, fluorescein dye applied and digital images recorded from both eyes of the horses after preanaesthetic medication and 24 hours after recovery from general anaesthesia. A paraffin-based bland ophthalmic ointment was applied on the ocular surface intraoperatively following collection of a sample into a sterile container. All samples underwent aerobic, anaerobic and fungal culture. Subject demographics, chronology of ophthalmic ointment use, anaesthesia duration, recumbency after induction, during surgery and recovery, fluorescein uptake and culture results were recorded. Descriptive statistics were performed. RESULTS Complete data were collected from 34 horses; six (17.6%) developed mild unilateral generalized fluorescein uptake consistent with corneal abrasions. Recumbency on the operating table was the only risk factor significantly associated with corneal abrasions. A total of 11 bacterial species were identified; Staphylococcus spp. (15 eyes) and Micrococcus spp. (eight eyes) were the most frequently isolated bacteria. Two fungal species were isolated postoperatively (Aspergillus spp., Saccharomyces spp.) in two eyes. Ointment contamination was recorded in two cases (5%) but cross-contamination was not recognized. CONCLUSIONSAND CLINICAL RELEVANCE Incidence of corneal abrasion/ulceration in horses undergoing general anaesthesia and contamination rate of ophthalmic solutions are similar to those previously reported in dogs.
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Affiliation(s)
- Stefania Scarabelli
- Phillip Leverhulme Equine Hospital, Institute of Veterinary Science, University of Liverpool, Liverpool, UK.
| | - Dorina Timofte
- Veterinary Pathology and Public Health Department, Institute of Veterinary Science, University of Liverpool, Liverpool, UK; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Fernando Malalana
- Phillip Leverhulme Equine Hospital, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - David Bardell
- Phillip Leverhulme Equine Hospital, Institute of Veterinary Science, University of Liverpool, Liverpool, UK; Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK
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Abstract
PURPOSE To ensure optimal care of patients, cornea specialists measure corneal features, including epithelial defects (ED), with slit-lamp calipers. However, caliper measurements are subject to interphysician variability. We examined the extent of variability in ED measurements between cornea specialists and discuss the potential clinical impact. METHODS A total of 48 variably sized EDs were created in pig eyes. Three cornea specialists measured the maximum vertical and horizontal ED lengths to the nearest 10th of a millimeter using slit-lamp microscopy. An absolute difference in ED measurement between cornea specialists of 0.5 mm was chosen to be the a priori threshold for clinical significance and was evaluated by the Wilcoxon signed-rank test. Interrater reliability was assessed by intraclass correlation coefficients. RESULTS The average absolute difference in the vertical ED length between pairs of examiners ranged from 0.54 to 0.63 mm, and that of the horizontal ED length ranged from 0.44 to 0.46 mm. These differences in ED measurement were not significantly different from 0.5 mm (all P > 0.06). However, pairs of examiners differed in vertical ED length measurements by >0.5 mm in 44% to 52% of EDs and by >1.0 mm in 13% to 17% of EDs. Pairs of examiners differed in horizontal ED length measurements by >0.5 mm in 31% to 40% of EDs and by >1.0 mm in 10% to 15% of EDs. The intraclass correlation coefficient was 0.85 (95% confidence interval, 0.77-0.91) for vertical and 0.84 (95% confidence interval, 0.74-0.90) for horizontal ED measurements. CONCLUSIONS Cornea specialists showed good reliability in the measured EDs; however, depending on the threshold for clinical significance, a nontrivial percentage of cases have high interexaminer clinical variability.
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Affiliation(s)
- Purak C. Parikh
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nita G. Valikodath
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher B. Estopinal
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Roni M. Shtein
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alan Sugar
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
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15
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Zernii EY, Gancharova OS, Ishutina IE, Baksheeva VE, Golovastova MO, Kabanova EI, Savchenko MS, Serebryakova MV, Sotnikova LF, Zamyatnin AA, Philippov PP, Senin II. [Mechanisms of perioperative corneal abrasions: alterations in tear film proteome]. Biomed Khim 2017; 62:683-690. [PMID: 28026813 DOI: 10.18097/pbmc20166206683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Perioperative corneal abrasion is an ophthalmic complication commonly found in patients underwent general anesthesia. In this study, correlations between development of corneal injury and proteomic changes in tear film during general anesthesia were examined using an animal (rabbit) model. Being started after 1-h anesthesia, the process of accumulation of pathological changes in the cornea unequivocally led clinically significant abrasions following 3-6 h of the narcosis. The corneal damage was associated with alterations in profiles of major proteins of the tear film. Analysis of the tear proteome pointed to depression of lachrymal glands function, and suggested serotransferrin, serum albumin and annexin A1 as potential tear markers of the complication. The tear film alterations included fast drop of total antioxidant activity and activity of superoxide dismutase, and decrease in interleukin-4 and increase in interleukin-6 content indicating development of oxidative and pro-inflammatory responses. These findings suggest antioxidant and anti-inflammatory therapy as prospective approach for prevention/treatment of perioperative corneal abrasions. The observed anesthesia-induced effects should be considered in any study of ocular surface diseases employing anesthetized animals.
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Affiliation(s)
- E Yu Zernii
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - O S Gancharova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - I E Ishutina
- Skryabin Moscow State Academy of Veterinary Medicine and Biotechnology, Moscow, Russia
| | - V E Baksheeva
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - M O Golovastova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - E I Kabanova
- Skryabin Moscow State Academy of Veterinary Medicine and Biotechnology, Moscow, Russia
| | - M S Savchenko
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - M V Serebryakova
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - L F Sotnikova
- Skryabin Moscow State Academy of Veterinary Medicine and Biotechnology, Moscow, Russia
| | - A A Zamyatnin
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia; Sechenov First Moscow State Medical University, Institute of Molecular Medicine, Moscow, Russia
| | - P P Philippov
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - I I Senin
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
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16
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Beal C, Giordano B. Clinical Evaluation of Red Eyes in Pediatric Patients. J Pediatr Health Care 2016; 30:506-14. [PMID: 26948259 DOI: 10.1016/j.pedhc.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/06/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis can be readily identified in many patients. Identifying conditions that threaten vision and understanding the urgency of referral to an ophthalmologist is paramount. Some systemic diseases such as leukemia, sarcoidosis, and juvenile idiopathic arthritis can present with the chief symptom of a red eye. Finally, trauma, ranging from mild to severe, often precipitates an office visit with a red eye, and thus understanding the signs that raise concern for a ruptured globe is essential. In the primary care setting, with a focused history, a few simple examination techniques, and an appreciation of the differential diagnosis, one can feel confident in managing patients with acute red eyes.
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Abstract
Pain involving the eye has numerous etiologies and is a feared challenge of many clinicians. Between a fear of the patient losing vision and a lack of familiarity with the ophthalmic equipment necessary to diagnose the problem, working up eye pain can be a daunting task. While the ophthalmologist can be indispensable in challenging cases of eye pain, this article will help clarify the unique clinical features of each etiology that can help clinicians narrow down the differential and arrive at a diagnosis.
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Affiliation(s)
- Corey W Waldman
- Sinai Hospital, Krieger Eye Institute, Baltimore, MD 21215, USA
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18
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Abstract
BACKGROUND The penetration of robotic technology in various surgical fields may increase ocular complications. METHODS A systematic search was performed in both PubMed and Scopus databases. RESULTS Eight articles were retrieved by the literature search. In total, 142 patients were included in the study. The most frequent complication was increased intra-ocular pressure. Corneal abrasion, ischaemic optic neuropathy and postoperative visual loss were also reported. The duration of operations was 1.7-9.9 h; mean intra-ocular pressure was 3.6-13.3 mmHg; estimated blood loss was 29.7-1200 ml; and administered intravenous fluids were 1.600-4.300 ml. CONCLUSIONS Meticulous preoperative ophthalmological assessment, restriction of intravenous fluids, 'rest stops', eyelid taping and ocular dressings are the major protective measures suggested by the literature. Collaboration between the surgical team and the anaesthetist is also essential. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica 'KAT', Athens, Greece
| | - Andreas Karydis
- Bristol University Eye Hospital, Glaucoma Department, Bristol, UK
| | - Stavros I Tyritzis
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Centre of Minimally Invasive Urological Surgery, Athens Medical Centre, Athens, Greece
| | - Christos Iavazzo
- Gynaecological Oncology Department, Christie Hospital, Manchester, UK
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Abstract
AIM To report various ocular lesions caused by accidental instillation of superglue. METHODS Three cases of ocular injuries are described in children aged 6 years, 3 years and 8 months, following accidental instillation of superglue in the eye. RESULTS In the first case there was sticking of eyelashes in the medial 1/3 of eyelids in both eyes. In the second case sticking of eye lashes was present in the lateral 1/3 of eyelids in the left eye. In the third case, superglue was present on the right cheek, above the right ear and sticking of eyelids in medial 1/3 in right eye. The eyelids were separated by pulling the lid margins with fingers in the first case and later on superglue was removed by trimming the eyelashes; and by direct trimming the eyelashes in second and third cases. There was no injury to other structures of anterior segment in the first two cases. However, removal of the superglue on the cornea resulted in corneal abrasion in the third case which healed with medical treatment and patching of the right eye. CONCLUSION Accidental instillation of superglue is possible because of the appearance of the tube like eye ointment tube. Immediate medical aid will prevent ocular morbidity.
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Affiliation(s)
- Sagili Chandrasekhara Reddy
- Department of Ophthalmology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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20
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Faraldi F, Papa V, Santoro D, Rasà D, Mazza AL, Rabbione MM, Russo S. A new eye gel containing sodium hyaluronate and xanthan gum for the management of post-traumatic corneal abrasions. Clin Ophthalmol 2012; 6:727-31. [PMID: 22654499 PMCID: PMC3363309 DOI: 10.2147/opth.s31776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the effects of an ophthalmic gel containing sodium hyaluronate and xanthan gum in addition to the antibiotic netilmicin in the management of traumatic corneal abrasions. PATIENTS AND METHODS PATIENTS WITH TRAUMATIC CORNEAL ABRASIONS WERE RANDOMLY TREATED AS FOLLOWS: Group A (n = 20) with an occlusive patching for 12 hours plus one drop of an eye gel containing 0.15% sodium hyaluronate, 1% xanthan gum and 0.3% netilmicin qid for 5 days; and Group B (n = 20) with an occlusive patching for 2-3 days plus one application of 0.3% netilmicin ophthalmic ointment qid for 5 days. All patients were evaluated after the third and seventh day by slit-lamp examination, fluorescein staining, and corneal defect photograph in order to assess corneal re-epithelialization. Conjunctival hyperaemia, lid oedema, subjective symptoms of discomfort, and conjunctival swabs were also evaluated. RESULTS No statistically significant difference was observed between the groups in terms of the extent of corneal healing after 3 days of treatment. Both treatments were also highly effective in decreasing the erosion score and the conjunctival hyperemia (P < 0.0001, P < 0.005, respectively) without any significant difference between the two types of treatment. Subjective symptoms of discomfort and conjunctival swabs were also evaluated. CONCLUSION In the management of traumatic corneal abrasions, the administration of an eye gel containing sodium hyaluronate and xanthan gum is able to reduce the length of occlusive patching. In addition, the presence of netilmicin guarantees good antibiotic prophylaxis during the wound repair process.
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Affiliation(s)
- Francesco Faraldi
- Department of Ophthalmology III, Presidio Ospedaliero Oftalmico, Torino, Italy
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21
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Abstract
CLINICAL QUESTION What is the best treatment for traumatic corneal abrasion? RESULTS Eye patching does not reduce pain in patients with corneal abrasions. Topical diclofenac does reduce pain in patients with corneal abrasions IMPLEMENTATION Pitfalls to avoid when treating abrasions: Treatment of small abrasions Treatment of larger abrasions When to refer for specialist treatment.
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Abstract
INTRODUCTION Neurotrophic keratitis, a degenerative corneal disease caused by trigeminal nerve impairment, has many etiologies and remains very difficult to treat. METHODS Case report of a 23-year-old male with a right corneal ulcer that failed to improve despite broad-spectrum antimicrobials. RESULTS Prior diagnosis of disseminated lymphangiomatosis with a lesion in the right petrous apex effacing Meckel's (trigeminal) cave in conjunction with a history of nonhealing corneal abrasions suggested a neurotrophic etiology. Drawstring temporary tarsorrhaphy, in addition to antibiotics and autologous serum, lead to successful clearing of the infection and resolution of the corneal ulcer. Visual acuity improved from light perception (LP) at the peak of infection to 20/40 six weeks after treatment. CONCLUSIONS To our knowledge, we report the first case of neurotrophic keratitis in a patient with disseminated lymphangiomatosis that caused a mass effect in Meckel's (trigeminal) cave leading to compression of the trigeminal nerve. The antibiotic-resistant corneal ulcer was successfully treated with drawstring tarsorrhaphy, confirming the utility of this therapeutic measure in treating neurotrophic keratitis.
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Affiliation(s)
- Jared E Knickelbein
- Department of Ophthalmology.,Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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