To the Editor

We also share concern regarding the potential for corneal injury in the perioperative period. We would like to add another possible mechanism of injury during minimally invasive surgery, after which the patient, who suffers less postoperative pain, may be more acutely aware of other discomforts. We have noticed that the edema of the dependent eye(s) may force the lid(s) slightly open, thus allowing dryness, irritation, and potential self-inflicted injury after emergence. We see this in robotic-assisted radical prostatectomy, in which the patient is in head-down position for hours, or laparoscopic radical nephrectomy, in which 1 eye is dependent for hours. The solution, for which we give credit to anesthesiologists at City of Hope Hospital in Los Angeles, is to lubricate the eyes, tape them both vertically and horizontally, and, finally, to place a Sun-Med I Guard Eye Protector (Sun-Med Division of Azimuth, Largo, FL) mask over the eyes. At the end of the case, tape is removed, eyes are rinsed, and mask is replaced over the eyes until patient is wide-awake in the recovery room. Patients are warned they will be arriving in the recovery room wearing a blue super-hero mask. A small pinhole can be made in the clear eye shield part of the mask to prevent fogging.

Debra E. Morrison, MD
Anne B. Wong, MD
University of California, Irvine
Orange, CA
Associate Professor of Anesthesiology
Texas A&M Health Sciences Center
Temple, TX