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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. · 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. TM 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.