General anesthesia leads to a reversible loss of consciousness and muscle tone, including the loss of protective reflexes such as blinking and tear production. As a result, the eyes are vulnerable to drying, corneal abrasions, and inadvertent trauma. The inability to blink and reduced tear secretion can cause the cornea to become dry and susceptible to injury within minutes of anesthesia induction. Given the sensitivity of the corneal surface and the potential for permanent damage, protecting the eyes by taping them closed is a standard and often necessary practice during anesthesia 1,2.
Taping the eyes shut during anesthesia serves two primary functions: to prevent corneal drying and to shield the eyes from mechanical injury. After induction, the eyelids often remain slightly open due to loss of tone in the orbicularis oculi muscle; this partial closure can expose the cornea to the air, leading to desiccation and subsequent epithelial damage. In addition, surgical drapes, instruments, or personnel contact pose a risk of injury to the eye. Taping creates a physical barrier that helps maintain a moist environment and prevents accidental contact.
Eye taping is usually performed after ensuring that the eyes are closed gently, without pressure on the globe. A piece of hypoallergenic surgical tape is applied horizontally or diagonally over each eyelid. Care is taken not to tape the eyelids too tightly, as excessive pressure can cause increased intraocular pressure or bruising. In some settings, particularly for longer procedures or in patients at higher risk of ocular injury, additional protection such as eye ointment or transparent dressings may be applied before taping 1–3.
Corneal abrasion is an anesthesia-related complication which can occur when the eyes are unprotected. The majority of these injuries are minor and self-limited but can result in significant discomfort postoperatively, including tearing, photophobia, foreign body sensation, and delayed discharge. In rare instances, more serious complications like infections or scarring can occur, especially in patients with pre-existing ocular conditions. Prophylactic eye taping has been shown to significantly reduce the incidence of these injuries 4,5.
Certain patient populations may require extra attention to eye protection. Additionally, during procedures involving prone or lateral positioning, there is a heightened risk of pressure on the eyes, which can contribute not only to corneal injury but also to rare complications. Preventive measures should be taken accordingly 6,7.
Taping the eyes closed during anesthesia is a simple, low-cost intervention with significant benefits. By preventing corneal drying and trauma, it helps avoid one potential postoperative complication. When done properly, eye taping is a safe and effective standard of care that exemplifies the proactive risk reduction strategies central to modern anesthetic practice.
References
- Hariharan, U. Comprehensive eye care: A simple step toward a better outcome. J Anaesthesiol Clin Pharmacol 28, 279 (2012). DOI: 10.4103/0970-9185.94934
- Prakash, S. Perioperative eye protection under general anesthesia. J Anaesthesiol Clin Pharmacol 29, 138–139 (2013). DOI: 10.4103/0970-9185.105834
- Shamim, R., Riaz, R., Patro, A. & Priya, V. Use of surgical tapes for eye protection: An eye opener. Anesth Essays Res 10, 687–689 (2016). DOI: 10.4103/0259-1162.191112
- Liyew, T. M., Mersha, A. T., Admassie, B. M. & Arefayne, N. R. Risk stratification, prevention and management of perioperative corneal abrasion for non-ocular surgery: Systematic Review. Ann Med Surg (Lond) 86, 373–381 (2023). DOI: 10.1097/MS9.0000000000001566
- Bright, M. R., White, L. D., Concha Blamey, S. I., Endlich, Y. & Culwick, M. D. Perioperative corneal abrasions: A report of 42 cases from the webAIRS database. Anaesth Intensive Care 51, 63–71 (2023). DOI: 10.1177/0310057X221099032
- Shamim, R., Riaz, R., Patro, A. & Priya, V. Use of surgical tapes for eye protection: An eye opener. Anesth Essays Res 10, 687–689 (2016). DOI: 10.4103/0259-1162.191112
- Chua, A. W., Kumar, C. M., Chua, M. J. & Harrisberg, B. P. Anaesthesia for ophthalmic procedures in patients with thyroid eye disease. Anaesth Intensive Care 48, 430–438 (2020). DOI: 10.1177/0310057X20957018