- Letter to the Editor
- Open Access
Selfie ensures eye safety
Ain-Shams Journal of Anesthesiology volume 15, Article number: 28 (2023)
To the editor,
Prone positioning is commonly used to access the posterior fossa, craniovertebral junction of the neck, spine fixations, endourosurgical procedures, and retroperitoneal surgeries (Kwee et al. 2015). Prone positioning has its impediment, and postoperative vision loss (POVL) is often reported, despite its low overall incidence, chiefly because of the pressure on anterior structures of the eye (Kwee et al. 2015). POVL is frequently involved in malpractice claims and litigations, complicating further research of its causative factors (Mendel et al. 2017). Following spine surgery, postoperative vision loss (POVL) occurs between 0.1% and 0.2% of the time. Ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO), and cortical blindness are the three most frequent causes of vision loss (Mendel et al. 2017). Both anterior and posterior ION (PION) is possible after surgery, PION being more prevalent because the small pial vessels supplying it cannot be controlled by autoregulatory mechanisms. Raised IOP is one of the risk factors for the development of ION, among other things (Gerber et al. January 2021). A raised IOP combined with hypotension during surgery and intraoperative anaemia can cause optic nerve ischemia. Extrinsic ocular pressure from the headrest may lead to central retinal artery occlusion (Gerber et al. January 2021). Reasonably so, the anaesthesiology team is wary of ocular protection during prone positioning. Most often, it is a protocol to check that the eyes are free from pressure from the headsets. Visual inspection in the form of bending under and checking, use of a mirror (Lin et al. 2020) and a video laryngoscope (Mukherjee and Alam 2014) are most often done. Some horseshoe headsets are pre-fitted with mirrors to ease this process of bending down to check the eyes (Mukherjee and Alam 2014). A smartphone in today’s time has undeniably become an inseparable part of everyone's daily routine. And we advocate the use of the front-view capture/ selfie mode to visualise and ensure the safety of eyes in prone positioning. It is a readily available resource, easy to use and can also be used for record-keeping for medico-legal purposes in case of an unforeseen unfortunate event or litigation.
Availability of data and materials
Post-operative vision loss
Central retinal artery occlusion
Ischemic optic neuropathy
Gerber D, Eberle B, Erdoes G (2021) Checking the integrity of eyes in prone position: a novel application of video laryngoscopes. SAGE Open Medical Case Reports. https://doi.org/10.1177/2050313X211015885
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Sophia Lin, LaSharVeA Bailey, Thai Nguyen et al. Extendable mirrors to improve anesthesia provider comfort for eye and positioning checks in prone patients: A pilot study. Journal of Patient Safety and Risk Management. 2020. https://doi.org/10.1177/2516043520914199
Mendel E, Stoicea N, Rao R et al (2017) Revisiting postoperative vision loss following non-ocular surgery: a short review of etiology and legal considerations. Front Surg 4:34. https://doi.org/10.3389/fsurg.2017.00034
Mukherjee Bipasha, Alam Mohammad Shahid (2014) Acute visual loss with ophthalmoplegia after spinal surgery: Report of a case and review of the literature. Indian Journal of Ophthalmology 62(9):963–965. https://doi.org/10.4103/0301-4738.143951
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Bharadwaj, A., Dubey, R., Khetarpal, M. et al. Selfie ensures eye safety. Ain-Shams J Anesthesiol 15, 28 (2023). https://doi.org/10.1186/s42077-023-00329-3