To the Editor:
Postoperative eye pain can range from serious to inconvenient, but it is always disconcerting. This report concerns a 12-yr-old boy who underwent right anterior-lateral neck scar revision under halothane N2 O anesthesia. Induction with N2 O-O2 and halothane was easy; no struggling occurred. The patient's rather deep-set eyes were taped from the upper medial orbit to the lower lateral cheek. Laryngeal mask airway (LMA) was placed with ease, and the patient was draped with his head turned to the left. As far as could be ascertained the surgeon did not press on the eye.
After the case was finished and local injection was completed, the LMA and eye tape were removed and the mask was applied. No cough or excitement occurred, but immediately upon awakening the patient complained of right eye pain and had obviously red conjunctiva. The eye was irrigated and fluroescein was instilled, but no corneal abrasion was seen. An ophthalmologist was consulted, also saw no abrasion, and applied tetracaine drops for pain control. By the next morning, the patient was asymptomatic.
When discussing the complications with another ophthalmologist, the following mechanism for the pain was proposed. This boy had rather deep-set eyes, and, when the lids were taped, the upper lid was pulled over the lower lid so that the lower lashes rubbed against the lid conjunctiva, causing the irritation and pain. This has been noted with the elderly, who have lax lids, but is apparently unusual in children.
Meticulous attention to the detail of just approximating the lids would have avoided this problem and allowed an uneventful anesthetic. I believe I have seen this problem at least once before but did not recognize its cause.
F. Robert Weis, MD
Department of Anesthesiology, University of South Alabama Medical Center, Mobile, AL 36617