Keratitis Secondary To General Anesthesia: A Case Report.

The cornea is a particularly fragile structure due to its avascular epithelial structure. The central oxygenation of the cornea is provided directly by atmospheric oxygen dissolved in the tear film.

A reduced oxygen supply, associated with a dry environment, quickly leads to epithelial desquamation at the origin of corneal abrasion.

General anesthesia favors this situation by several mechanisms: incomplete spontaneous occlusion of the eyelids (lagophthalmos), loss of blink and Bell reflexes, reduction in the production of the tear film associated with an alteration of its mechanical properties.

The aim of our work is to show that corneal damage is the most common ocular complication of general anesthesia in order to prevent it.

We report the case of a 23-year-old patient with no particular pathological history, who presented painful red eyes with a sensation of foreign bodies, photophobia and tearing, 24 hours after an appendectomy performed under general anesthesia.

 

The ophthalmological examination finds:

A visual acuity of 10/10 in both eyes.

Bilateral ocular involvement made up of significant diffuse superficial punctate keratitis and conjunctival inflammation. The rest of the exam is normal.

The patient was put on artificial tear eye drops without preservatives and a healing ointment with vitamin A.The evolution was marked by a total improvement of the ocular signs without sequelae.

Corneal lesions (especially superficial) are the most common ocular complications during general anesthesia (1/1000).

Roth et al. reported that the risk factors for the occurrence of corneal damage are the duration of anesthesia, general anesthesia, surgery of the face or neck, or lateral decubitus.

The analysis of complaints for ocular lesion showed that 16% of postoperative corneal lesions were definitive.

The origin of corneal lesions is very variable. The common mechanism is a defect in palpebral occlusion (80% of cases) and/or accidental contact of the cornea with an external object (20% of cases).

They can occur during the induction of anesthesia, during ventilation with a face mask, during intubation or even during the intervention.

To prevent corneal lesions during general anesthesia, systematic lid occlusion with adhesive strips alone is recommended.

It is recommended to obtain the complete occlusion of the eye by affixing the upper and lower eyelids together and to regularly check the effectiveness of this occlusion.

For risky surgeries (head and neck surgery, procedure in prone or lateral position), it is probably recommended to use lubricants in combination for lid occlusion with adhesive strips.

The establishment within the structures of a training program and an injury prevention protocol is probably recommended in order to reduce the incidence of corneal injuries under general anesthesia.