page_title: Eye injuries during general anaesthesia
section_title: Discussion of methods
hierarchical_section_title: Eye injuries during general anaesthesia / Discussion of methods
caption_attribution_description: English: Tape awaiting placement
context_page_description: Eye care during general anaesthesia is an important part of anaesthesia care. Eye injuries are reasonably common if care is not taken to prevent them.
context_section_description: The most commonly employed method is to use tape or a general purpose adhesive dressing.  Unfortunately the adhesive used on the tape or dressing will generally be inappropriate for this use. The adhesive strength may change when reaching body temperature, or over time.
  
  As the operation progresses this can cause the adhesive to stop working and become gooey, allowing 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 bruising, tears, or eyelash removal.
  Rolls of tapes are often “laying around” the operating theatre or kept in health care workers' pockets.
  Therefore, they can be a source of hospital-acquired infections (HAI's) such as Methicillin-resistant Staphylococcus aureus (MRSA) & Vancomycin-resistant Enterococcus (VRE), with a 2010 study showing that 50% of partially used tape rolls tested positive for MRSA, VRE or both.
  Most tapes and dressings are non-transparent 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 medications.
  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 hyperemia. 
  They have been implicated in blurred vision in up to 75% of patients and they do not protect from direct trauma.
  Specially made eyelid occlusion dressings are available commercially, such as EyeGardᵀᴹ (manufactured in the USA by KMI Surgical and marketed by Sharn Anesthesia), EyeProᵀᴹ (Innovgas Pty Ltd, Australia) and Anesthesia-Aid (Sperian Protection).  These dressings overcome most of the problems associated with tape or general purpose dressings.
caption: Tape awaiting placement
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