Disclaimer: This article is intended solely for informational and educational purposes only. It does not constitute medical advice.
Postoperative corneal abrasion is the most frequently reported ocular complication following non-ocular surgery performed under general anesthesia. Symptoms include eye irritation, tearing, sensitivity to light, blurred vision, and the sensation of a foreign body in the affected eye. The development of postoperative corneal abrasion is closely related to physiologic changes that occur during general anesthesia that leave the ocular surface vulnerable to drying and mechanical injury (1).
General anesthesia increases the risk of corneal injury by disrupting the eye's normal protective mechanisms. After induction, suppression of the blink reflex and incomplete eyelid closure reduce the eye's ability to maintain a stable tear film, allowing the corneal surface to dry during surgery. At the same time, Bell's phenomenon (the upward rotation of the globe that normally protects the cornea when the eyelids close) is diminished under general anesthesia, leaving the corneal epithelium more vulnerable to injury. Once the ocular surface has been compromised, even minor contact with surgical drapes, face masks, or other equipment around the head may result in epithelial abrasion. The risk is further increased during prolonged procedures and operations requiring prone or lateral positioning (1).
Because postoperative corneal abrasion is largely preventable, perioperative care focuses on protecting the ocular surface throughout the duration of anesthesia. Prompt eyelid closure after induction, followed by secure taping to maintain complete eyelid closure, helps minimize corneal exposure during surgery. Although lubricating ointments were previously used routinely, current evidence suggests they offer little additional protection when the eyelids are adequately taped and may contribute to postoperative blurred vision or ocular irritation. Maintaining eye protection throughout the procedure, particularly during prolonged operations or patient repositioning, further reduces the likelihood of corneal injury (2).
Patients with postoperative corneal abrasion typically become symptomatic in the post-anesthesia care unit or within the first several hours after surgery, most commonly with acute eye pain, tearing, photophobia, and a foreign body sensation. The diagnosis is confirmed by fluorescein staining, which highlights the epithelial defect under cobalt blue illumination. Because the clinical presentation may resemble more serious ocular injuries, careful assessment is necessary to distinguish a simple corneal abrasion from conditions such as infectious keratitis, penetrating globe injury, or acute angle-closure glaucoma. Findings including marked visual loss, an irregular pupil, evidence of penetrating trauma, or persistent or worsening symptoms should prompt urgent ophthalmologic evaluation (3).
Management of postoperative corneal abrasion is directed toward relieving symptoms, promoting epithelial healing, and preventing secondary infection. Because the corneal epithelium regenerates rapidly, most uncomplicated abrasions resolve within 24 to 72 hours with conservative treatment. Supportive care typically consists of preservative-free lubricating drops or ointment and oral analgesics, while topical antibiotics may be used for larger epithelial defects or in patients considered to be at greater risk of infection. Routine eye patching is no longer recommended because studies have not shown it to improve healing, and it may delay recovery. Patients who wear contact lenses warrant closer attention because of their increased risk of infection with Pseudomonas species and may require antibiotic therapy with appropriate gram-negative coverage (3).
Although postoperative corneal abrasion rarely causes permanent visual impairment, it remains an important source of postoperative discomfort and can negatively affect the patient's recovery experience. Consistent eye protection during anesthesia remains the most effective strategy for preventing this complication. When abrasions do occur, prompt recognition and appropriate treatment generally result in rapid healing with little risk of long-term sequelae.