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Perioperative Corneal Abrasions After Nonocular Surgery

A Systematic Review

Papp, Alexandra M., MD*; Justin, Grant A., MD†,‡; Vernau, Christian T., MD§; Aden, James K., PhD; Fitzgerald, Brian M., MD§; Kraus, Gregory P., MD§; Legault, Gary L., MD†,‡

doi: 10.1097/ICO.0000000000001972

Purpose: To perform a systematic review of the international literature evaluating the risk factors, preventative steps, and treatments for perioperative corneal injuries for nonocular surgery.

Methods: PubMed, Embase, and Evidence-Based Medicine Reviews databases were searched on April 13, 2018. Two hundred four articles were identified with 16 meeting the inclusion criteria. All studies were evaluated for quality and level of evidence. Two types of studies were included. The first were primary epidemiological studies that looked at the rates of perioperative corneal injuries after nonocular surgery and the second were trials that either studied preventative steps or treatments.

Results: A statistical analysis was completed to reveal trends in perioperative corneal abrasions. Rates ranged from 0.01% to 59% with a cumulative rate of 0.64% (95% confidence interval 0.36%–1.35%). Primary risk factors were identified as longer procedures, general anesthesia, and advanced age. The most commonly associated ocular injuries were found to include chemical injury, conjunctivitis, blurred vision, and conjunctival congestion. Treatment strategies for corneal abrasion in the literature recommended erythromycin ointment and ample ocular lubrication for the fastest recovery. Education interventions alone, as studied in 2 of the 16 articles, demonstrated a significant decrease in the rate of corneal abrasions.

Conclusions: Standardized ocular protection, reporting, and education initiatives were found to maximally decrease rates of perioperative corneal abrasions after nonocular surgery. However, no gold standard currently exists for intraoperative ocular protection. More research needs to be conducted on specific prevention strategies and content of educational initiatives in hopes of standard development across facilities nationwide.

*McChord Airman's Clinic, Madigan Army Medical Center, Joint Base Lewis McChord, Tacoma, WA;

Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX;

Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD;

§Department of Anesthesia, Brooke Army Medical Center, San Antonio, TX; and

San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, San Antonio, TX.

Correspondence: Grant A. Justin, MD, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78219 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government.

Received October 29, 2018

Received in revised form March 10, 2019

Accepted March 13, 2019

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