Postoperative Eye Pain

Unexpected postoperative eye pain is usually caused by corneal abrasion or an acute glaucoma attack, the former being the more common source. During general anesthesia, the blinking reflex is lost, and both basal and reflex tear production decreases. A dry, exposed cornea is at high risk for abrasion. Intraoperative measures such as using nonionic petroleum-based eye ointment, avoiding rubbing of the eye, using a protective scleral shell, and taping or suturing the eyelids closed are useful in preventing eye injury. Eye ointment itself, however, may cause irritation.

Corneal abrasion pain is a specific eye pain characterized by a sensation of the presence of a foreign body in the eye, tearing, conjunctivitis, and photophobia. Corneal abrasion pain is made worse by blinking. The abraded section of cornea may be seen directly as a dull nonreflective patch or as a positive area on fluorescein staining. Treatment requires the application of antibiotic eye ointment and covering of the eye with a patch for at least 48 hours. Topical application of anesthetic drops and steroids to the cornea is contraindicated because they retard healing. If pain persists more than 24 hours, an ophthalmologist should be consulted.

Acute glaucoma may be manifested as severe, diffuse periorbital pain in a dry, pale eye with a dilated pupil. No photophobia, tearing, or conjunctivitis occurs. The globe will feel firm to palpation. Vision may decrease as IOP increases. Initial treatment to reduce IOP includes the intravenous administration of either 20% mannitol (1 g/kg) over a 30-minute period or 500 mg of acetazolamide over a 5-minute period. Nausea and vomiting may accompany the aforementioned symptoms and may, in fact, dominate the clinical picture.