Introduction
Ophthalmic complications are seen in some cases of non-ocular surgeries using general anesthesia. Injuries caused by surgical drapes, injuries due to the anesthetic agent or surgical equipment, or inadequate lid closure can be some of the causes of eye injuries. Corneal abrasion is one of the most commonly reported ophthalmic complications seen in non-ocular surgeries under general anesthesia.
Can Anesthesia Cause Vision Problems?
Blurry vision after surgery can be a short-term side effect of anesthesia and can be seen even in nonocular surgeries. It is still debatable as to whether anesthesia or some components in the anesthetic agent can actually be a cause for vision problems. Some experts believe that the anesthetic agents can cause the eye to become dry, leading to eye injuries. Eye issues due to factors other than anesthesia can include improper closing of the eyelids during the procedure, injuries caused by the drapes used, injuries due to some equipment used in the procedure, etc. Another common ophthalmic complication frequently observed in nonocular surgeries under general anesthesia is corneal abrasion.
Other injuries observed are due to some chemicals that came in contact with the eye during the procedure, pressure on the eyes as a part of the procedure, or issues that can disrupt the blood supply to the optic nerve. The patient's position during the surgical procedure can also have an impact on causing ophthalmological complications during anesthesia.
What Is Corneal Abrasion?
Corneal abrasion is one of the most common ophthalmic complications seen in nonocular surgical procedures using general anesthesia. A cut or scratch in the cornea is called corneal abrasion. The cornea is the transparent portion of the superficial layer of the eye. It is one of the most thickly innervated parts of the body. Hence, pain due to a corneal injury can be more severe than the pain due to the procedure itself. Decreased tear production as an effect of the anesthetic agent used can also cause corneal abrasion.
Corneal abrasion usually heals on its own without any treatment. But the scar it causes can remain in the cornea.
What Are the Other Eye Damage Seen After Anesthesia?
Eye problems after anesthesia that are less common include:
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Loss of Vision: Injuries that can cause a loss of vision are rare following a surgical procedure using anesthesia. It could be due to the pressure applied to the eyeball during the procedure. It can affect a nerve or blood vessel supplying the eye, causing ischemia in the eye (limited blood supply in the eye). The position of the patient during the procedure can have an impact on increasing pressure on the eye. Though rare, some surgeries on the spine have been associated with vision loss following the procedure.
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Droopy Eyelid: This could be due to increased pressure on the nerves of the eye.
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Bruising Around Eyes: The use of tapes to bind the eyes, or ointments to prevent chemicals from entering the eye during the procedure to prevent corneal abrasion can cause bruises, redness, or irritation in the eye. Redness, irritation, and a feeling that something is on the eye can last for some hours following the procedure.
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Swelling in the Eyelids: Some procedures might require the patient to be in a head-down position. This is seen in some gynecological procedures. This can cause temporary swelling in the eyelids after a surgical procedure under general anesthesia.
What Could Be Done to Prevent Eye Injuries While Under Anesthesia?
Protecting the eyes carefully can help to prevent injuries during surgical procedures.
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Tapes: In procedures that can cause the eyes to become dry, it is recommended to bind them carefully using small pieces of tape so that the eyelids remain closed properly during the procedure. Studies show that taping the eyes during surgery actually helps reduce the risk of corneal abrasion. Bruising of the skin around the eyelid after anesthesia due to this is inevitable to an extent. This is especially true if the patient’s skin is very thin and can be easily bruised.
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Gels or Ointments: In some procedures, the anesthesiologist may advise the use of certain gels or ointments to moisten the eye during the procedure. This can be another protective precaution taken to prevent eye injuries. This is especially true in some cases where binding the eyelids might not provide a satisfactory result or in cases where the patient might not be able to close the eyelids completely. However, some ointments might cause eye irritation or redness of the eye following anesthesia. These are temporary and will return to normal within a few hours.
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Eye Cushions or Googles: In some cases, like a surgical procedure on the spine, the patient might have to lie down facing the floor (lying on the patient’s front). In such cases, the anesthesiologist may consider some measures to cover and protect the eye. This can include eye cushions, goggles, or eye pads. They protect the patient’s eye from being rubbed or scratched by a foreign body.
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Hydro-Gel Eye Patch: It is an eye dressing consisting of a polymer called hydrogel. When positioned properly, these high polymers help to maintain uniform eyelid closure. It acts as a mechanical barrier and prevents trauma, injury, or infection. The patches also contain materials to maintain high humidity, which, in turn, helps prevent eye drying.
Conclusion
Studies show that protection of the eye is mandatory in all surgical procedures under general anesthesia. Understanding the risk factors and conditions that can play a role in formulating strategies for preventing eye damage while under general anesthesia. The strategies to reduce eye damage should be followed from the induction of anesthesia until the patient recovers completely during the postoperative period. Minor complications like dehydration or other superficial trauma in the eye can be managed appropriately. These are short-lived and resolve rapidly during the postoperative period. However, these can also be minimized by achieving proper ocular occlusion (proper closure of the eyelids) and the use of gels or ointments that help to maintain humidity within the eye. Following proper protocols helps to prevent complications during the postoperative period for the patient and avoids inconvenience to the surgeons, anesthesiologists, and other staff involved in the surgical procedure.
