Episode #326 Corneal Abrasions After Surgery

Opening Clip: True or False? You do not need to call an ophthalmology consult for a patient in the recovery room with a corneal abrasion and significantly reduced visual acuity. Okay, we have time for one more. True or False. You need to call an ophthalmology consult for any patient with a postoperative corneal abrasion.

Thanks for taking our quiz. This is the Anesthesia Patient Safety Podcast and I’m your host, Alli Bechtel. We are catching up on some APSF Newsletter articles today. First up, we are returning to the topic of postoperative corneal abrasions. You may remember that we talked about a postoperative protocol for patients with corneal abrasions back in July for episode #314. Today, we are returning to that topic, but this time we are bringing you the perspective of the ophthalmologists.

Before we dive further into the episode today, we’d like to recognize Nihon Koden, a major corporate supporter of APSF. Nihon Koden has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Nihon Koden, – we wouldn’t be able to do all that we do without you!”

Our featured article is “Perioperative Corneal Abrasions from an Ophthalmologist’s Perspective”

by Dmitry Pyatetsky and Jeanine Baqai. This article was published online June 29th, 2026. This is the first time we are featuring ophthalmologists on the podcast so that’s pretty cool. To follow along with us, head over to APSF.org and click on the Newsletter heading. The first one down is APSF Newsletter articles. Then, scroll down until you get to our featured article and I will include a link in the show notes.

You may remember the last time we talked about postoperative corneal abrasions and the awesome multidisciplinary collaboration between anaesthesiology and ophthalmology departments. It led to a simple protocol for anesthesiology professionals to treat simple corneal abrasion in the PACU, which led to decreased unnecessary ophtho consults, and increased patient satisfaction. Here’s a refresher on the protocol:

• The patient reports eye pain or the PACU nurse notes conjunctival injection.
• This triggers a call from the PACU nurse to the anesthesia resident.
• The anesthesia resident then performs an eye exam in the PACU, assessing for vision changes, injection, tearing, photophobia, or a gritty sensation. At this point, if there is any severe vision loss, ophthalmology is consulted.
• The next step is for the anesthesia resident to administer the fluorescein strip and take a look with the cobalt light from the ophthalmoscope. These supplies, the fluorescein strip and the ophthalmoscope are stored in the PACU. If there is no corneal defect, then the patient is given artificial tears, 1 drop in the affected eye every 30 minutes for 2 hours.
• If there is a corneal defect, then the patient is given 0.5% erythromycin ointment in each eye every 4 hours. For patients with symptoms that last for more than 24 hours, this is when a consult to ophthalmology is made for inpatient or follow-up with ophthalmology is arranged as an outpatient for patients who were discharged home.

I wonder if any of our listeners have been able to adopt a similar protocol at your institution. If not, what are you waiting for? In the meantime, let’s take a look at this from the ophthalmology perspective. This is a letter to the editor article. While this is the most common ocular complication associated with non-ocular surgery and can be very distressing for patients, most of the time these are superficial epithelial injuries that will heal within 2-3 days with out any further complications. If we step back and look at the big picture here, routine ophthalmology consultation for uncomplicated corneal abrasion just not needed and can lead to delayed patient discharge from the PACU, increased costs, and inefficient use of resources. A systems-based, anesthesia-led triage and management protocol is great and provides timely recognition, appropriate treatment, and escalation of care when needed…so there are safe guards in place when things don’t go as planned. Uncomplicated cases have an intact globe, no red flags, and expected clinical improvement. These can be managed with a streamlined, ophthalmic antibiotic-based protocol with supportive lubrication and monitoring and patient education. This protocol nicely aligns with the APSF’s mission to promote evidence-informed high-value perioperative care, so that’s really exciting too.

This is a space where anesthesia professionals can work to help prevent and manage this complications. We know the risk factors for postoperative corneal abrasion…but if we’ve forgotten a few, that’s okay because we are going to review them now. Check out Table 1 in the article to following along for the key risk factors.

First up, patient related risk factors include: Advanced age; dry eye disease; recurrent corneal erosion; prior ocular trauma; contact lens use; prominent eyes/proptosis.

Anesthesia related ones are General anesthesia; prolonged duration (>60–90 min); reduced tear production; loss of corneal reflex.

There are positioning related factors including Prone, lateral, or Trendelenburg positions; dependent eye exposure; external globe pressure.

Risk factors related to the surgery include head and neck surgery as well as longer procedures.

And finally perioperative care factors include Inadequate eyelid closure; lack of eye protection; oxygen mask trauma; postoperative eye rubbing.

Okay, the first step is knowing the risk factors and working hard to prevent this complication. Then, we have a clear protocol in place to recognize, diagnose, and treat. We also need to make sure that there are clear escalation criteria to help keep patient safe. So, all this talk about anesthesia professionals managing this complication, but we also need to call that ophthalmology consult when it is needed…for patients with atypical features, concerning examination findings, or deviations from the usual, expected course. Be on the lookout for persistent or worsening pain beyond 24-48 hours, visual acuity changes, corneal infiltrate, or signs of infection.,..this is when you need an urgent ophthalmology consult. Check out Table 2 in the article for a list of these escalation triggers. You can even print these out and put them in your PACU or make it part of your next teaching session. Here are the escalation triggers:

• Significantly reduced visual acuity or persistent visual disturbance
• Worsening or non-improving pain after 24 hours, especially in a contact lens wearer
• Persistent pain beyond 48 hours
• Failure of epithelial healing by 72 hours
• Corneal infiltrate, ulceration, or suspected infection
• Fixed, irregular, or dilated pupil
• Hyphema or hypopyon
• Suspected penetrating injury or foreign body
• Corneal defect involving stroma
• Dendritic fluorescein staining

There are a couple of other things we need to be careful about according to the ophthalmologists. In general, the use of topical anaesthetics or topical nonsteroidal anti-inflammatory agents for pain control should be avoided. The risks likely do not outweigh the short term pain relief benefit since the risks are corneal toxicity, delayed healing, and masking of clinical deterioration. For these regular, uncomplicated cases, oral analgesics plus lubrication, and reassurance provide good symptom control without increasing the risks.

And what about patients who wear contact lens?  This is a special population and we need to consider substituting out the erythromycin and using fluoroquinolone coverage instead since there is more common colonization with pseudomonas aeruginosa.

Well, the ophthalmologists have weighed in and the verdict is clear. For uncomplicated perioperative corneal abrasions, anesthesia professionals should feel confident to diagnose and manage these patients with an anesthesia-led, antibiotic-based protocol with clear safety escalation triggers. This way we can improve efficiency and patient satisfaction, reduce unnecessary consultations, and most importantly, keep patients safe. Now go out there and put this on your next anesthesia department meeting agenda. Remember our quiz from the top of show…the correct answers are both False! As we talked about, you do not need to call a consult for every corneal abrasion case as long as you have your protocol in place with clear escalation triggers, but you do need to call for patients with significantly reduced visual acuity.

We have time for one more article. So, let’s check out the July 13^th Letter to the Editor article by Williams and colleagues, “Useability of Baxter Novum Syringe Pump in Rapid Turnover Procedural Areas. Thank you so much to James and your colleagues for submitting this letter to the editor. I don’t use these syringe pumps and I know not all of our listeners are users of this specific pump but anesthesia professionals frequently use infusion pumps to deliver medication so this is still of interest as a patient safety issue when problems with using a smart pump means that the safety benefits are not realized and this is especially true in high turnover areas. Okay, so here’s the story. In June 2024, Baxter Novum syringe pumps were introduced at the author’s institution. There were issues with using these new pumps in high turnover procedural areas leading to decreased use compared to previous generations of the pumps. After 4-5 months, use of the new pumps increased back to above the baseline levels.

The authors tried to figure out why this happened by undertaking a survey that asked for a narrative assessment and the Microsoft Copilot AI was used to summarize responses with the following prompt:

“Please summarize the following comments with language appropriate for a health care administrator.”

Here is the AI summary that was generated:

“The new syringe pumps are seen as cumbersome and time-consuming to program, with too many steps and redundant questions, particularly when changing syringe sizes, which requires restarting the entire process. This complexity and the inability to quickly swap syringes are viewed as unsafe, especially in fast-paced or critical care settings, leading some practitioners to avoid using them altogether. While the screen’s brightness is appreciated, the overall user interface is considered distracting and inefficient, impacting patient care and increasing medication waste and costs. The pumps are perceived as more suitable for inpatient use rather than procedural and operating settings.”

What a cool use of AI to help understand what was happening when it comes to use of the new pumps. The authors then combined the survey data and smart pump usage data to reach the conclusion that the decreased smart pump usage for several months was due to usability issues.

We have talked about medical safety and smart infusion pumps on the podcast before. You can check out episode, “#146 A Smart Way to Keep Patients Safe from Medication Errors” for a refresher. You might be thinking, well it just sounds like this anesthesia department just didn’t like the new pumps, but this is a bigger patient safety issue since the Institute for Safe Medication Practice sets a 95% compliance goal for smart infusion pump use and research has been done to develop frameworks for usability…and some health systems even use human factors testing to help inform procurement of new devices. This makes sense because it can be a costly and necessary investment. You can turn to the Food and Drug Administration, or FDA, for published examples of reported infusion pump problems that sound similar to what’s going on here with usability issues. The association for the Advancement of Medical Instrumentation focuses on human factors engineering and also has examples of pump usability and being able to update pumps wirelessly. The authors highlight that what they experienced with these smart pumps at their institution is likely due to the combination of high turnover areas and administration of intravenous anesthesia medications. For example, on the medical ward, nurses may use an infusion pump with the same size syringe every time to give antibiotics, but anesthesia professionals may need to be able to change the syringe size quickly for the same patient while providing anesthesia.

A multidisciplinary team from the manufacturer visited the University of North Carolina in September 2024 and entered into ongoing discussions. Perhaps in the future the user interface and programming options on these smart syringe pumps may be adapted to work well for anesthesia professionals in high turnover areas. This is likely an area where anesthesia professionals  and the APSF and regulatory agencies all work together to improve smart infusion pump especially for the end user while helping to maintain medication safety in all patient care areas.

Before we go, let’s check out the response from Baxter Healthcare Corporation. I’m going to read it now!

“Baxter’s mission is to Save and Sustain Lives and this concept is embedded into everything we do as a company, including product development and implementation – from idea inception, through product design and verification, and ultimately to our products’ use in patient care. This includes the Novum IQ Syringe infusion pump (Novum syringe), which received FDA clearance in 2023.

Infusion pumps are complex medical devices, and Baxter designed this pump to support complex infusion practices with a focus on patient safety and improved efficiency for clinicians. Thus, the design process for the Novum syringe included multiple clinician advisory meetings, a series of human factors studies involving multidisciplinary clinicians including anaesthesiologists, and extensive internal testing by both Baxter’s Research and Development engineers as well as Baxter clinicians. That said, we expect the real-world implementation of our devices to offer opportunities to learn, adapt and improve, and we greatly value the collaborative feedback and discourse with Dr. Williams and his team at the UNC Health Anesthesia department.”

Thank you so much to the APSF authors and Baxter Healthcare for helping us to learn more about these syringe pumps including the incredible amount of work that went into developing this new smart pump and we are looking forward to seeing what’s next in this space.

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

Thanks for listening to the Anesthesia Patient Safety Podcast.

We hope today’s conversation gave you something you can take back to your practice or your department and share with your team. If you enjoyed the episode, please like, subscribe, and share it with a colleague. We’re glad you’re here.

Until next time, stay vigilant and stay informed so that no one shall be harmed by anesthesia care.

© 2026, The Anesthesia Patient Safety Foundation