Peri-operative eye protection: A change for the better

Prevention of eye injury during general anaesthesia is of utmost importance and is a cornerstone of peri-operative patient care. However, until recently there has been a lack of formal national and local guidelines around best practice in this domain. A recent local staff survey has shown variation in eye protection practices and has prompted work to reduce the risk of eye injury at Manchester University Hospitals. Methods Following review of the literature and recent years' incident reports related to peri-operative eye injury in non-ophthalmic surgery, an audit on peri-operative eye protection was registered with our audit department. Data were collected via a questionnaire distributed at Manchester Royal Infirmary and Trafford General Hospital aimed at peri-operative staff (anaesthetists of all grades, anaesthetic nurses and operating department practitioners). The questions focused on the various methods used for eye protection (tape, ointment or both), technique and site of ointment application if used, direction of tape application, frequency of intra-operative eye checks and awareness of staff with regards to evidence on best practice. This was conducted over a period of 2 weeks and 81 anonymised responses were received. Results Analysis of the data showed 43% of responders were unaware of evidencebased best practice. The most common method of eye protection used was the combination of Transpore tape with ointment, practised by 92.5% of responders. Incorrect technique and site of application of eye ointment was described by 27.8% of responders. Regular hourly intra-operative eye checks were performed by only 11%, while infrequent and no eye checks at all combined together represent 81% of responders. Discussion The literature suggests that peri-operative eye injury is rare but can be painful and distressing to patients [1]. The French Society for Anaesthesia and Intensive Care (SFAR) published guidance [2], in 2017, which recommends the use of adhesive tape alone. The literature did not support combining ointment and adhesive tape is superior to adhesive tape alone. Frequent intra-operative inspection of the eyes is also recommended. Consequently, comprehensive local guidance has been produced, a successful trial of commercial tape specifically for eye protection carried out and has recently been introduced in our Trust.