Prevention of Eye Injury in Periorbital Interventions

Guidelines for Prevention of
Eye Injury in IR

During interventions for orbital or periorbital malformations, the eye is left open to facilitate ultrasound imaging and access. The risk to the eye during these procedures increases as these patients are typically under anaesthesia. General anaesthesia may reduce eye closure, tear production and stability resulting in corneal epithelial drying and reduced protection.

Eye injury

The most likely reason for eye injury leaving the eye open and unprotected. Less commonly, trauma and chemical irritation from cleaning solutions (e.g. povidone-iodine(Betadine), chlorhexidine or alcohol) may lead to eye injury.

Types of Eye Injury

Exposure keratopathy/keratitis: The most common injury and caused by drying of the cornea with subsequent epithelial breakdown. Exposure keratitis may occur from cleaning solutions such as povidone-iodine (Betadine), chlorhexidine or alcohol
Corneal abrasions: If the cornea sticks to the eyelid, an abrasion may occur when the eye opens. This can be very painful, hamper recovery and rarely lead to partial or complete visual loss. Symptoms are often transient including foreign-body sensation, redness, pain, tearing, and photophobia

Treatment

Ophthalmologic consult immediately. Initiate antibiotic ointment immediately and patching the injured eye shut. Healing of keratitis usually occurs within 24 hours.

How to reduce eye injury in IR?

For eye prep, Povidone-Iodine 5%(Betadine) is used. This can be made by diluting povidone-iodine Betadine 10% with equal volume of saline. Chlorhexidine may be toxic to cornea.
Simple, frequent manual closure of the eyelids
Holding the eyelids shut with ultrasound probe during the US exam
Use of topical antibiotic ointment (e.g.erythromycin5 mg/g)
Avoid pressure and direct contact of ultrasound probe with the globe
Gentle, frequent saline irrigation