Comparison of Eye Protection Methods of Ointment Instillation under General Anesthesia

Seung Hoon Yoo; Hyuna A Kim; Sang Il Ahn; Soon Im Kim; Jin Kwon Chung

doi:10.3341/jkos.2015.56.7.1012

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Yoo, Kim, Ahn, Kim, and Chung: Comparison of Eye Protection Methods of Ointment Instillation under General Anesthesia

Original Article

J Korean Ophthalmol Soc 2015;56(7):1012-1019.

Published online: 27 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.1012

Comparison of Eye Protection Methods of Ointment Instillation under General Anesthesia

Seung Hoon Yoo, M.D¹, Hyuna A Kim, M.D², Sang Il Ahn, M.D³, Soon Im Kim, M.D, PhD⁴, Jin Kwon Chung, M.D^1,

Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea

Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Jin Kwon Chung, MD Department of Ophthalmology, Soonchunhyang University Seoul Hospital, #59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea Tel: 82-2-709-9354, Fax: 82-2-710-3196 E-mail: schcornea@schmc.ac.kr

* This study was presented as a narration at the 113th Annual Meeting of the Korean Ophthalmological Society 2015.

Received 27 February 201511 May 2015 Accepted 4 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To compare the efficacy of 3 different eye ointment instillations with eyelid taping and eyelid taping alone to prevent eye complications during surgery under general anesthesia.

Methods:

A total of 296 eyes of 148 patients who underwent general anesthesia for at least 60 minutes were randomly assigned to 1 of the following 4 groups: group A, eyelid taping alone; group B, eyelid taping with solcoseryl ointment; group C, eyelid taping with carbomer ointment; group D, eyelid taping with lanolin ointment. Schirmer test, tear film break-up time (TF-BUT), con-junctival hyperemia scale (CHS), National Eye Institute corneal staining scale (NSS), and ocular surface disease index (OSDI) were prospectively evaluated before and after general anesthesia.

Results:

TF-BUT was significantly increased in the group B compared with the preoperative value ( p = 0.035). CHS was sig-nificantly decreased in all 3 ointment groups ( p < 0.05) after general anesthesia and the degree was significantly higher in groups B and C ( p < 0.001). No corneal abrasion developed after general anesthesia. However, corneal erosion developed in 20 eyes of previously healthy subjects; 8 eyes (12.5%) in group A, 0 eye (0%) in group B, 2 eyes (2.5%) in group C, and 10 eyes (13.9%) in group D. The occurrence rates of new lesions were significantly lower in groups B and C ( p = 0.035).

Conclusions:

Both eyelid taping alone and eyelid taping with eye ointment are effective protection methods against corneal abra-sion during operation under general anesthesia. Eye ointment instillation together with eyelid taping shows not only improvement of subjective symptoms but also improvement of objective ocular surface parameters proving to be an effective ocular protection during general anesthesia.

Keywords: Corneal abrasion, Corneal erosion, Eyelid taping, General anesthesia, Ointment

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Figure 1.

Comparison of ocular surface parameters after general anesthesia in each group. Significance of the p is de-fined as less than 0.05 by paired t-test. Group A is treated with taping alone. Group B is treated with taping and sol-coseryl ointment, Group C is treated with taping and carbom-er ointment and Group D is treatemd with taping and lanolin ointment. TF-BUT = tear film break-up time; OSDI = ocu-lar surface disease index; NSS = National Eye Institute (NEI) staining scale; CHS = conjunctival hyperemia scale.

Table 1.

Clinical characteristics and ocular surface parameters before the surgery by group

	Group A	Group B	Group C	Group D	p-value
Age (years)	47.63 ± 12.27	47.20 ± 11.15	45.19 ± 12.30	48.06 ± 10.39	0.602^∗
Sex (n)
Male	30	26	36	24
Female	34	54	44	48	0.739^†
Anesthesia time (minute)	162.34 ± 79.55	154.25 ± 76.38	159.85 ± 83.02	167.50 ± 82.16	0.490^∗
Schirmer test (mm)	9.09 ± 4.99	8.73 ± 6.53	9.20 ± 8.06	7.86 ± 4.89	0.802^∗
TF-BUT (second)	5.41 ± 2.80	6.03 ± 3.03	5.55 ± 2.99	5.39 ± 2.50	0.742^∗
OSDI	7.88 ± 11.64	9.19 ± 8.35	9.28 ± 8.54	6.99 ± 8.17	0.658^∗
NSS (score)	0.63 ± 0.94	0.45 ± 0.96	0.35 ± 0.86	0.44 ± 0.91	0.655^∗
CHS (score)	0.59 ± 0.56	0.47 ± 0.53	0.51 ± 0.31	0.50 ± 0.53	0.194^∗

Values are presented as mean ± SD. Group A is treated with taping alone. Group B is treated with taping and solcoseryl ointment, Group C is treated with taping and carbomer ointment and Group D is treatemd with taping and lanolin ointment.

TF-BUT = tear film break-up time; OSDI = ocular surface disease index; NSS = National Eye Institute (NEI) staining scale; CHS = conjunctival hyperemia scale.

^∗ By analysis of variance (ANOVA) test;

^† By Chi square test.

Table 2.

Mean changes of the ocular surface parameters after general anesthesia among groups

	Group A	Group B	Group C	Group D	p-value^∗
Shirmer test (mm)	-1.09 ± 6.12	1.73 ± 4.75	0.78 ± 6.12	-0.53 ± 5.02	0.126
TF-BUT (second)	-0.31 ± 2.46	0.13 ± 1.76	0.73 ± 2.10^†	-0.25 ± 2.27	0.132
OSDI	-3.98 ± 7.90^†	-4.11 ± 4.36^†	-3.90 ± 5.44^†	-2.80 ± 7.00^†	0.772
NSS (score)	-0.09 ± 1.09	-0.50 ± 0.75	-0.10 ± 0.50	0.14 ± 1.07	0.370
CHS (score)	-0.06 ± 0.44	-0.29 ± 0.48^†	-0.38 ± 0.41^†	-0.17 ± 0.38^†	<0.001
T^‡	a	b	b	a

Values are presented as mean ± SD unless otherwise indicated. Group A is treated with taping alone. Group B is treated with taping and solcoseryl ointment, Group C is treated with taping and carbomer ointment and Group D is treatemd with taping and lanolin ointment.

TF-BUT = tear film break-up time; OSDI = ocular surface disease index; NSS = National Eye Institute (NEI) staining score; CHS = conjunctival hyperemia score.

^∗ Statistical significances were tested by one-way analysis of variance (ANOVA) among groups;

^† Statistical significances were tested by paired t-test within group;

^‡ The same letters indicate non-significant difference between groups based on Turkey's honestly significant difference (HSD) multiple comparison test.

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