The need for eye protection during general anaesthesia and the efficacy of various eye protection methods


  • Twinkle Ann George Department of Ophthalmology, ACME, Pariyaram, Kerala, India
  • Biju Abraham Department of Anaesthesiology, ACME, Pariyaram, Kerala, India
  • Nikhil George Consultant Cardiac Anaesthesiologist, Pala, Kottayam, Kerala, India



Basal tear volume, Eye protection, Fluorescein staining, Hydroxy propyl methyl cellulose eye ointment, Paraffin based eye ointment, Schirmer’s test score, Taping of eye


Background: Patients undergoing prolonged non-ocular surgery with general anaesthesia may develop ocular complications. Previous studies suggested that prophylactic ocular care should include prevention of mechanical exposure of cornea and replacement of deficient tears.

Methods: To assess the basal tear volume with various eye protection methods during general anaesthesia so as to find the need of eye protection and also to compare and assess the efficacy of lid taping with hypo allergenic adhesive surgical paper tape, paraffin based lubricant eye ointment, 2% hydroxyl propyl methyl cellulose tear substitute ointment and combinations of these ointments with lid taping as eye protection methods during general anaesthesia, the study was conducted in a tertiary care centre during the period of 1 year among 200 patients (400 eyes) undergoing general anaesthesia. After obtaining written informed consent they were subdivided into four groups of fifty patients each by randomization. A multiple cross over design with four groups each divided into two sub groups for eye protection methods was done. Corneal staining by fluorescein and basal tear volume assessment by Schirmer’s test were done pre-and postoperatively. Significance is assessed at 5 % level of significance. Student t test (two tailed, dependent) has been used to find the significance of study parameters (schirmer’s test score) on continuous scale within each group.

Results: The percentage of difference of schirmer’s test score pre-and post-operatively were almost the same in all methods.

Conclusions: Eye protection is mandatory in all cases under general anaesthesia. There was almost equal effectiveness for all eye protection methods analysed.


Krupin T, Cross DA, Becker B. Decreased basal tear production associated with general anaesthesia. Archives of Ophthalmology. 1997;95:107-8.

Roth S, Thisted RA, Erickson JP, Black S, Schreider BD. Eye injuries after non-ocular surgery. A study of 60965 anaesthetics from 1988-1992. Anesthesiology. 1996;85(5):1020-7.

Cucchiara RF, Black S. Corneal abrasion during anaesthesia and surgery. Anaesthesiology. 1988;69:978-9.

Snow JC, Kripke BJ. Corneal injuries during general anaesthesia. Anaesthesia Analgesia. 1975;54:465-7.

Murray WJ, Ruddy MP. Toxic eye injury during induction of anaesthesia. South Med J. 1985;78:1012-3.

Williams EL, Hart WM. Postoperative ischemic optic neuropathy. Anaesthesia Analgesia. 1995;80:1018-29.

Segal KL, Fleischut PM, Kim C, Levine B, Faggiani SL, Banerjee S, et al. Evaluation and treatment of perioperative corneal abrasions. J Ophthal. 2014; 2014.

Cross DA, Krupin T. Implications of the effects of general anaesthesia on basal tear production. Anaesthesia Analgesia. 1977;56:35-7.

Prakash S. Perioperative eye protection under general anaesthesia. J Anaesthe Clinical Pharmacology. 2013;29(1):138-9.

Stulting RD, Mader TH, WaringIII GO. 'Diagnosis and management of Tear film function', in Lebowitz HM, Waring III, G.O. 2nd ed. Corneal Disorders clinical diagnosis and management. Philadelphia: Saunders. W.B. 1998:487-8.

Grover VK, Kumar KV. Comparison of methods of eye protection under general anaesthesia. Canadian J Anaesthes. 1998;45(6):575-7.

Batra YK, Bali IM. Corneal abrasion during general anaesthesia. Anaesthesia Analgesia. 1977;56(3):363-5.

Kocatürk O, Kocatürk T, Kaan N, Dayanir V. The comparison of four different methods of perioperative eye protection under general anesthesia in prone position. J Clin Anal Med. 2012;3:163‑5.

Bøggild-Madsen NB, Bundgarrd-Nielsen P. Comparison of eye protection with methyl cellulose and paraffin ointments during general anaesthesia. Canadian Anaesthetist's Society J. 1981;28(6):575-8

Manecke GR Jr, Tannenbaum DP, McCoy BE. Severe bilateral corneal injury attributed to a preservative‑containing eye lubricant. Anaesthesiology. 2000;93:1545‑6.

Orlin SE,Kurata FK. Ocular lubricants and corneal injury during anaesthesia. Anaesthesia Analgesia. 1989; 69: 384-5.




How to Cite

George, T. A., Abraham, B., & George, N. (2017). The need for eye protection during general anaesthesia and the efficacy of various eye protection methods. International Journal of Research in Medical Sciences, 5(4), 1224–1229.



Original Research Articles