Section 5:

Eye damage

Risks associated with your anaesthetic

Section 5: Damage to the eye during

general anaesthesia

D uring a general anaesthetic it is possible for your eyes to be damaged. This

is an uncommon or rare event. The types of damage that can occur, and
its consequences and treatment are described in this article.
Damage caused during surgery to the eye itself or associated with anaesthesia
for eye surgery is not described here. You can talk about this with the eye
surgeon or specialist anaesthetist who is looking after you.

What is the most common type of 4 The eye’s blood supply may be
damage? affected for another reason, such
The most common type of damage to the as a low blood pressure during the
eye that can occur during or after a general operation.
anaesthetic is a corneal abrasion.1,2 Overall, it is very rare to suffer any of
these problems and lose sight in an eye.
A corneal abrasion... Loss of sight following general anaesthesia
The cornea is a superficial clear layer of is so rare that it is difficult to give an
the eye. An abrasion is a tear or graze of accurate figure for the risk: one large
this layer. Corneal abrasions often heal study found that it occurred in 1 of over
without long-term effects on vision, but 60,000 patients studied.2
a scar may remain on the cornea. This
Other possible eye problems following a
may not be noticed during normal vision
or it may cause a dark or blurred spot in
general anaesthetic may include:
the affected eye. 4 Pressure on nerves in the eyebrow
area may cause a droopy eyelid.
4 Protective tape or eye ointments used
What other damage can occur? to protect your eyes from corneal
Eye injuries leading to loss of eyesight are abrasions may cause temporary
very rare.3 These include: bruising of the eyelids or irritation of
4 Pressure may be accidentally placed on the eyes.1 Redness of the eye, blurred
the eyeball during surgery. This could vision and the feeling that there is
cause an injury to the eye or block something in the eye may last for up
the eye’s blood supply. Pressure may to eight hours.
be more likely if you are positioned 4 A few operations are performed
face down to facilitate your operation. in an extreme head down position
Anaesthetists are trained to take a great (for example, some gynaecology
deal of care to position your head and operations). This can lead to swelling
neck, but it can be difficult to achieve of your eye lids which usually resolves
a good position when you are face within a short time.
down, especially in people who are 4 If you have glaucoma (giving you
overweight. Operations on the spine high pressures inside your eye) your
have been particularly linked with anaesthetist will need to take extra
sudden loss of vision, although this care to protect your eyesight during
remains uncommon. surgery.

1 Risks associated with your anaesthetic v Information for Patients: The Royal College of Anaesthetists
 Section 5:
Eye damage

Anaesthetists are trained to take care that

The rest of this article describes the cause, nothing rubs against your eyes. If your
treatment and consequences of corneal surgery requires you to be positioned lying
abrasions.
on your front (e.g. back surgery), special
goggles, cushions or eyepads may be used to
How do corneal abrasions happen? protect your eyes.
Most abrasions happen because your eye
does not close fully during the anaesthetic How often do corneal abrasions
and the cornea becomes dry. The dry occur?
cornea may stick to the inside of the
Following a general anaesthetic, it is
eyelid and the abrasion occurs when the
uncommon to suffer from a corneal
eye opens again.
abrasion that causes symptoms. A large
Approximately 6 out of 10 people (60%) study of over 60,000 patients having
do not close their eyes naturally when general anaesthetics found that about 1
they have a general anaesthetic.1 In in 1,750 patients suffered from a corneal
addition, fewer tears are produced during abrasion that caused symptoms.2
an anaesthetic causing dryness in the
The risk may be higher during certain
eyes.
types of surgery. A study of over 4,500
Corneal abrasion can also occur because patients having brain or spinal surgery
something rubs against the exposed cornea found that about 1 in 580 patients suffered
while you are anaesthetised. This may from a corneal abrasion.5
be a surgical drape or other equipment.
Other studies, using a microscope to
Care is taken to protect your eyes, and to
examine the eyes following an anaesthetic,
ensure that they are fully closed during a
have found that small corneal abrasions
general anaesthetic.
may occur more commonly than this.
Around 1 in 25 patients may have small,
What is done to prevent corneal otherwise un-noticeable corneal abrasions,
abrasions? even when protective eye tape or ointment
Corneal abrasions can usually be prevented is used.4
by careful protection of the eyes.
You may be more likely to suffer from a
To prevent your eyes becoming dry, corneal abrasion if your surgery requires
small pieces of sticking tape are used to you to be positioned lying on your front
help your eyelids close properly during or your side, if your operation lasts a long
your anaesthetic. This has been shown to time, or if you are having surgery on your
reduce the chances of a corneal abrasion head or neck.2
occurring.1,4 Bruising of the eyelid can occur
when the tape is removed, especially if you What if I already have poor vision?
have thin skin and bruise easily. If you have poor vision, it is helpful if
Sometimes, your anaesthetist may use a gel, you tell your anaesthetist about it. This
an ointment or eye-drops to moisten your is because he/she can give you any extra
eyes during your anaesthetic. These may be information that you need to help you feel
helpful if tape cannot be used or if your eyes at ease if you cannot see well. However,
need to be opened briefly during some types this will not make any difference to the
of surgery.5 Eye ointments can sometimes risk of getting a corneal abrasion, or to the
cause temporary eye irritation or blurring of ways in which your anaesthetist cares for
vision following an anaesthetic. your eyes while you are anaesthetised.

2 Risks associated with your anaesthetic v Information for Patients: The Royal College of Anaesthetists
 Section 5:
Eye damage

What happens if I have a corneal When it is healed there may be a scar

abrasion? on the cornea. The effect of the scar on
vision will depend on how big it is and
Corneal abrasions may be very painful.
where it is on the cornea. Many corneal
Treatment is aimed at reducing pain abrasions heal and leave no effect on
and preventing an eye infection. It may vision, although an eye specialist will be
involve eye drops, ointments and an eye able to see the scar through a microscope.
patch, as well as pain-relieving medicines. Contact lens users should take advice
No surgical treatment is necessary. before using contact lenses again.
Healing usually takes a few days, after Occasionally the abrasion will be right in
which the pain will stop completely. the centre of the cornea and there may be
some long-term blurring of vision.

Authors References
Dr Nick Tarmey, FRCA 1 White E, Crosse MM. The aetiology and prevention
SpR Anaesthetics of peri-operative corneal abrasions. Anaesthesia
Southampton University Hospitals NHS Trust 1998;53:157–161.
2 Roth S et al. Eye injuries after nonocular surgery.
Dr Lucy A White, MA, MRCP, FRCA Anesthesiology 1996;85:1020–1027.
Consultant Anaesthetist 3 Rupp-Montpetit K, Moody ML. Visual loss as
Southampton University Hospitals NHS Trust a complication of non-ophthalmologic surgery:
A review of the literature. AANA Journal
Editor 2004;72(4):285–292.
Professor Chandra Kumar
4 Grover VK et al. Comparison of methods of eye
Consultant Anaesthetist
protection under general anaesthesia. Can J
The James Cook University Hospital
Anaesth 1998;45(6):575–577.
Middlesborough
5 Cucchiara RF, Black S. Corneal abrasion during
anesthesia and surgery. Anesthesiology 1988;69:978–
979.

The Royal College of Anaesthetists

Revised edition 2009
The material from this article may be copied for the purpose of producing information materials for
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The Royal College of Anaesthetists
website: www.rcoa.ac.uk
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The Royal College
of Anaesthetists This leaflet will be reviewed three years from the date of publication.

3 Risks associated with your anaesthetic v Information for Patients: The Royal College of Anaesthetists