Nasal secretions in ocular surgery under general and local anesthesia

To investigate the etiology of nasopharyngeal secretion reflux under anesthesia, which could contaminate the conjunctiva, we photographed, after preoperative nasal instillation of fluorescein, the faces of 224 consecutive patients having cataract surgery under general (n = 78) and local (n = 146) anesthesia. In 10 patients, extension of the neck and facial contour caused fluid to drain from the nose directly into the conjunctival cul-de-sac. Nine of the 78 patients under general anesthesia had nasal secretions on the face at the end of surgery, usually due to leaking around the endotracheal tube. Adjusting head posture by moderate neck flexion and taking care to prevent leakage around the endotracheal tube, together with antiseptic preparation of the nose, may prevent contamination of the operative field by nasal secretions.