Eyes being taped during anaesthesia
Methods to prevent intraoperative corneal injuries include simple manual closure of the eyelids, taping the eyelids shut, use of eye ointment (although this is controversial, see below), and bio-occlusive dressings. However, none of the protective strategies are completely effective; vigilance is always required i.e. the eyes need to be inspected regularly throughout surgery to check that they are closed.
For many years, in most Western countries, the eyes of patients undergoing general anaesthesia have been routinely taped or stuck down with adhesive dressings in an attempt to combat these problems.
Tensile forces on delicate eyelids during tape removal
Unfortunately many of the adhesives used on medical products today are inappropriate for their use. Their adhesive strength may change when reaching body temperature, particularly when left on for extended periods of time2.
As the operation progresses this can cause the adhesive to stop working and become gooey, causing the eyelids to move apart and leaving behind a sticky residue. This leaves the cornea exposed to epithelial drying and/or abrasions, sometimes caused by the tape that was originally applied to protect the cornea.
Alternatively, the adhesive strength may increase, which upon removal can result in eyelid tearing or bruising, or eyelash removal.
Translucent tape awaiting placement
Rolls of tapes are often "laying around" the operating theatre on counters or IV poles, or kept in healthcare workers' pockets3. Therefore they can be a source of hospital acquired infections (HAI's). A 2012 study showed that 51% of partially used tape rolls tested positive for MRSA, VRE or both4, and a 2004 study found that 74% of partially used tape rolls found in various hospital settings had some bacterial growth3, 5.
Most of these tapes are translucent and so it is not possible to see if the patient's eyes are opened or closed throughout the case. It is not uncommon for the eyelids to move open as the case progresses, even with adhesive tapes stuck onto them. In a practical sense, these medical tapes/dressings may be difficult to remove from a patient because their ends can become stuck flush with the skin. The possibility of tape removal causing trauma is also significantly increased in older people, people with sensitive skin, dermatitis, dehydration or side effects of medications6.
As noted above, there have been several studies looking at the efficacy and safety of eye ointments/lubricants as adjuncts with tape or as a stand-alone management for intra-operative eye closure. Unfortunately many in common use have problems. Petroleum gel is flammable and is best avoided when electrocautery and open oxygen are to be used around the face. Preservative-free eye ointment is preferred, as preservative can cause corneal epithelial sloughing and conjunctival hyperaemia7. They have been implicated in blurred vision in up to 75% of patients and they do not protect from direct trauma8, 9.
KLZ Medical Pty Ltd
PO Box 32 Lonsdale SA 5160 Australia
Tel: +61 8 7127 6526