Sir,
Lagophthalmos, loss of Bell's phenomenon coupled with reduced tear production during general anesthesia, results in drying of corneal epithelium. This makes cornea vulnerable to abrasions secondary to direct trauma from objects such as face masks, laryngoscopes, identification badges, stethoscopes, or drapes.[1] Closing the eyes with surgical tape with or without instillation of eye ointment is a routine, inexpensive method of eye protection during general anesthesia.[2] However, such a measure can cause trauma to the eyelids, resulting in eyelid edema and bruising.
We report a case of a 76-year-old male diagnosed with fracture of femur neck and listed for open reduction and fixation under general anesthesia. Surgery under spinal anesthesia was ruled out as the patient was suffering from multiple myeloma with multiple lytic lesions in the vertebra. As a routine protective eye care measure, eyes were closed with a surgical tape after instilling antimicrobial eye ointment. Intraoperative course was uneventful. Prior to extubation on removing the tape, edema and bruising of eyelids were observed [Figure 1].
Figure 1.
Surgical tape causing bruise and edema
Routine eye protection measures include the use of surgical tape or a general purpose adhesive dressing, specialized eye occlusion dressings, eye patches, ointments, and suturing.[3] Skin of the upper eyelid is thinnest in the body, with the lower eyelid skin being only slightly thicker. Minimal dermal tissue is associated with the eyelid skin. Therefore, there are chances of eyelid bruise and edema during general anesthesia due to a tightly adhered surgical tape or slight pressure. Cucchiara and Black suggested taping the eye immediately after the induction of anesthesia and leaving them taped till the end of the procedure. They considered the use of ointment as optional.[4] This has shown to minimize the incidence of corneal abrasion. However, a tightly adhered tape can cause bruising of the eyelids on removal. This risk is significantly enhanced in elderly, people with sensitive skin, dermatitis, dehydration, or side effects of medications.
This case shows a deleterious effect of using surgical tape for eye protection. The usual practice should be placing a roll of gauze piece over the eyes followed by taping. However, we propose another simple yet a useful addition to eye protection measures. We, apart from instilling eye ointment in the eyes, spread a thin film of eye ointment over the bulge of upper eyelid followed by taping of the eyes. This measure, by reducing the pressure exerted on eyelid skin, minimizes the trauma to eyelids both during the use and removal of tape without compromising eye care intraoperatively. The proposed method is loosely derived from amblyopia eye patch used in children for amblyopia correction. It comprises a central white nonadhesive part surrounded by an adhesive rim [Figure 2a and b]. In fact, an amblyopia eye patch costs Rs. 20, and it can be used for eye protection. We have used both the above-mentioned methods and found them to be effective in affording a protective eye cover.
Figure 2.
(a and b) Amblyopia eye patch used for eye protection
EyePro™ (Sentry Medicals, Australia), EyeGuard™ (KMI Surgical), and Anesthesia-Aid™ (Sperian Protection) are some of the commercially available eyelid occlusion dressings. However, their price limits their widespread use.
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Conflicts of interest
There are no conflicts of interest.
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