Download Reduction of Corneal Abrasions in GI Lab

Reduction of Corneal Abrasions in GI Lab Demonstrated with
Standardized Eye Care
Participants: T. Michael Truxillo, MD, Samita Das, MD, Jonathan Nussdorf, MD, Stuart Hart, MD,
William Sumrall, MD, Lucy Schultz, RN, Kim Knoll, CRNA
Introduction
Recently, the Anesthesiology Department began providing
anesthesia for upper GI procedures and colonoscopies at OMC.
After a short period of time, it was noted that there was a large
increase in the incidence of corneal abrasions.
Methods
A review of the cases revealed that most of the abrasions
involved colonoscopies and involved the “down” eye that was
resting on the pillow. A standardized protocol was developed
for management of eye care during these cases. This
included staff and patient education and taping the “down” eye
closed. The management of these cases was discussed in
the Anesthesiology Department’s patient safety conferences
and was documented in the department’s Standard Operating
Procedure manual. Additionally, the Ophthalmology department
was contacted to determine the necessity of ophthalmology
consults for all patients who reported symptoms of corneal
abrasions. A protocol was implemented which stated that
barring any obvious injury or no relief with the administration
of fluoroscein dye, an ophthalmology consult was not required.
Clear printed instructions are given to each patient or family
member whenever an abrasion occurs along with a prescription
for antibiotic ointment.
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Discussion
Results
Corneal Abrasion Fact Sheet
Why am I getting this Fact Sheet?
It appears that you have a corneal
abrasion from the symptoms that you have
described. As indicated in the anesthesia
consent form, a corneal abrasion is a
known complication that can sometimes
occur during a procedure in the absence
of negligence/wrongdoing by your health
care providers. We want to ensure
that you are fully informed as to what to
expect.
What is a corneal abrasion?
The cornea is the clear outer most layer of
the front of the eye. A corneal abrasion is
a scratch or irritation of the cornea. This
event is relatively common around the time
of surgery or a procedure.
How do I know if I have a corneal
abrasion?
The cornea is very sensitive, so a corneal
abrasion usually hurts. You may feel like
you have sand or grit in your eye, and your
eye may look red. Tears or blurred vision
may develop as a result. Light may hurt
your eye. You may experience a headache
when a corneal abrasion occurs.
What can cause a corneal abrasion?
There are two main types of corneal
abrasions while in the hospital. The
first type occurs when the cornea is
scratched. This typically occurs during
or after a procedure. The exact cause of
corneal abrasions is commonly not clear.
The second type occurs when the eyes
are not completely closed and a small area
may become dry. This is common under
general anesthesia and is why we routinely
lubricate and close your
eyes.
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Health System
What will my anesthesiologist do for my corneal
abrasion?
An anesthesiologist will check your eye for injury or grit. A
dye will be used to help make a scratch easier to see. The
dye contains a topical anesthetic which will help relieve the
pain associated with the abrasion.
The dye and the anesthetic go away
in a few minutes and the abrasion
sensation will return.
Once the diagnosis is confirmed, your
anesthesiologist will prescribe erythromycin eye ointment
to prevent any infections. Most small scratches heal within
one to three days. If the pain is not resolved in three days
you will need to follow up with the Ophthalmology Clinic
at 504-842-3995 Call them to set up an appointment at
the Ochsner Clinic most convenient for you. Inform them
that this is a follow up for a perioperative corneal abrasion
and you will be seen, usually on the same day. Charges
associated with this treatment will be billed in the usual and
customary manner.
Corneal abrasions continue to be the most
frequently reported ocular complication during
general surgery. This complication has been
delineated and improved. The incidence, etiology,
and effective measures for prevention in the GI
lab are not as clearly defined. In Anesthesiology’s
current practice, trends have been identified and
care strategies implemented with intent to minimize
this complication. In this environment, the majority
of these abrasions or complications resolve quickly
and require minimal therapy/consultations.
What if I wear contact lenses?
If you wear contact lenses, you have a higher risk of eye
infection. You will need to keep your contact lenses out while
the abrasion heals.
Do I need a patch for my eye?
No. In the past, doctors have told people with corneal
abrasions to wear eye patches. More recently, studies have
shown that eye patches do not help and may even make
things worse.
Summary
• You have experienced a perioperative corneal abrasion.
Common symptoms are light sensitivity and feeling like
something is in the eye.
• These injuries can be painful but usually resolve within 1-3
days.
• You will be prescribed erythromycin ointment to aid in the
healing process. Place a dab of ointment the size of a
grain of rice in the injured eye three times a day.
• If your pain is not resolved within three days, follow up
with the Ochsner Ophthalmology Clinic 504-842-3995.
• Questions or concerns: phone 504-842-9719 to speak to
one of our Anesthesia physicians.
Conclusion
After expanding Anesthesiology services to the GI
suite, corneal abrasions incidents were reported to
our department’s quality surveillance system. After
thorough analysis, potential causes were identified
and management strategies were implemented
to resolve this issue. An initial decrease in
overall incidence of corneal abrasions was noted.
Anesthesiology continues to track this very closely.
Future plans include trialing antibiotic drops
instead of ointment and different types of adhesive
tapes.