An analysis of perioperative eye injuries after nonocular surgery

Perioperative eye injuries, although rare, often lead to great discomfort and anxiety for patients. The purpose of this study was to explore the incidence and related risk factors of perioperative eye injuries.

We retrospectively analyzed the records of inpatients who underwent nonocular surgery under general anesthesia with intubation between October 2006 and December 2008. Incidents of eye injuries were extracted from the Department of Anesthesiology Quality Assurance Database of Chang Gung Memorial Hospital. Univariate analysis and logistic regression modeling were used to assess the risk factors.

A total of 75,120 cases were included in the study, of whom 17 (0.023%) were identified to have sustained perioperative eye injury. Corneal abrasion was the most common form of eye injury (10 patients; 59%). Patients who had been operated on in the prone position [odds ratio (OR), 10.8; 95% confidence interval (CI), 2.4-48.8] or lateral position (OR, 7.1; 95% CI, 1.2-43.2), those who had undergone head and neck surgery (OR, 9.3; 95% CI, 2.3-38.0), sustained intraoperative deliberate hypotension (OR, 8.7; 95% CI, 2.4-31.8), or who had preoperative anemia (OR, 5.3; 95% CI, 1.8-15.4) were more susceptible to eye injuries. The duration of anesthesia was not an independent risk factor (OR per hour, 0.9; 95% CI, 0.8-1.7).

In addition to head and neck surgery, operations in the lateral or prone position, preoperative anemia and intraoperative deliberate hypotension are also precipitating factors for perioperative eye injuries. For patients who are at high risk or for procedures that are apt to cause injury, preoperative recognition and intraoperative caution are of paramount importance.