Comparison of the different methods of eye protection in maxillofacial surgeries during general anesthesia

Abstract

Corneal abrasion is the most frequent ocular complication to occur during the peri-operative period. Those patients under going oral and maxillofacial surgery are in a higher risk of corneal abrasion because of the proximity of the orbits to the areas of surgery, Therefore protection of the eyes during oral and maxillofacial surgeries under general anesthesia (GA) is very important. There are independent factors related to ocular injuries such as : GA, head and neck surgeries and age. About 44% of unprotected eyes during general anesthesia could be injured Which can be a potential problem after GA. At this time there is no standard means of protecting the eyes used during GA in oral and maxillofacial surgeries and commonly is performed by taping the eyes which is in contrast with the sterility of the field of surgery also if the eyes were open under the tape it could be hazardous and tend to corneal abrasion, an other popular method is to use lipid base ointments for the protection of eyes during GA which has its own complication as blurred vision and allergic reactions, hydro gels has been used in some studies for eye protection during GA which has less complication than ointments with lipid base, also biologic dressing (opsite) has been used as eye protection during GA and trauma to the eyes has been decreased. According to the literatures to present a standard method for protection of the eyes during oral and maxillofacial surgeries under GA is necessary. The objective of this study is to compare the methods of eye protection during oral and maxillofacial surgery under general anesthesia . Methods: A double blinded clinical trial study on 75 (150 eyes) patients for oral and maxillofacial surgeries under GA were performe. Theses paitants has been visited in oral and maxillofacial department of Emam Reza hospital of Tabriz.-Iran. Informed consent obtained from each patient according to instruction of the ethics committee. The length of the operation was anticipated between 90-120 minutes, after selecting patients according to exclusion and inclusion criteria, patients were divided randomly to 5 groups of 15. After GA one of the methods were applied for each patient, which include: 1) hypo allergen tape; 2)ointment with lipid base; 3)hydro- gel; 4)artificial tear drop and 5)opsite. All 5 methods has been done by one person. One hour after surgery a clinician examined the cornea by a slit lamp biomicroscope and in the presence of corneal abrasion it would be documented also the questionnaire were completed by the investigator and patient together. Answers were rated on a scale consisting of 1 (yes), 0 (no). Statistic data were analyze using descriptive statistics and chi-square test. All the statistical calculation were carried out by statistical package spss for windows 13 software(statistical significance was assumed at P< 0/005). Discussion: There were no significant differences between the 5 groups and non of them caused corneal abrasion, no significant difference in subjective assessment could be found for ocular burning, itching and foreign body sensation also photophobia. 3 eyes in group tape were reported to have trauma to eye lids (10% )and also 2 eyes had traumatized eyelashes (6.7%), inaddition anesthetic team were unable to observe pupils dilution during surgery (p<0/001). 4 eyes in the group ointment with lipid base were reported to have blurred vision (13.3%) and it was meaning full in statistic analysis (p=0/004), also in the group opsite the anaesthetic team were unable to observe pupils in all 15 patents (p<0/001). There were no complication reported of the group hydro-gel and artificial tear. Result: In conclusion, all five methods used in our study had the same effect on preventing of corneal abrasion and no statistically significant difference was found. Nevertheless, based on the anecdotal incidence of complications observed in our study, unless the surgery requires observation of the pupils, the use of hydro gel and artificial tear drop seems to be a better choice.