Introduction

Corneal abrasion (CA) is the most common ocular adverse event from non-ocular surgery under sedation. CA is a known but rare complication after gastrointestinal endoscopy described in the left eye due to left lateral decubitus positioning for the procedure. Patients undergoing endoscopy after the onset of the COVID-19 pandemic were required to wear surgical masks during all endoscopic procedures (unless per-orum endoscopy) and post-procedurally in the recovery area. The aim of this quality improvement (QI) project was to chronicle the rate of CA in the COVID-19 era and determine the efficacy of a simple intervention for its prevention.

Methods

All patients undergoing endoscopy at our academic tertiary referral institution were screened for symptoms of CA in the endoscopy recovery area and via nurse phone call post-procedure. All CA were reported using an adverse event reporting system. Mandatory use of a surgical mask for all patients undergoing endoscopy was instituted on March 1, 2020. CA reporting prompted a QI intervention instituted on September 1, 2020 consisting of taping the surgical mask on the nose bridge to prevent caudal migration as well as bilateral taping of eyes. Adverse event rates of CA (AER-CA) were compared to endoscopy unit baseline for the 14 months prior to COVID-19 (PRE-COVID, January 1, 2019–February 29, 2020), during the COVID-19 era prior to QI intervention (PRE-QI, March 1, 2020 – August 31, 2020), and during the COVID-19 era post QI intervention (POST-QI, September 1, 2020 – November 30, 2020). AER-CA were compared using a Fisher’s exact test.

Results

A total of 16,107 patients underwent endoscopic procedures at our institution during the entire study period, of which 5,392 occurred during the PRE-QI and POST-QI periods. The baseline PRE-COVID AER-CA was 0.03% (3/10,715), with a notable increase in the PRE-QI AER-CA to 0.09% (3/3,243; p=0.14) with both left and right eye CA. In the POST-QI period, the AER-CA was 0 (0/2,149 procedures) with no CA reported.

Discussion

Changes to patient safety protocols in the COVID-19 era presented new challenges. Exacerbations of prior problems in the intra- and peri-endoscopic periods included increased CA now due to a new mechanism of caudal migration of the surgical mask resulting in CA to not only the left eye but now to the right eye as well. There was a marked increase in AER-CA in the PRE-QI era compared to PRE-COVID (p=0.14), and a clinically substantial decrease in AER-CA in the POST-QI period compared to PRE-QI period with complete prevention post-QI, albeit non-statistically significant due to low overall total numbers of CA. Implementation of a simple QI intervention with taping of the surgical mask to nose bridge and taping bilateral eyes closed is an efficacious method of preventing CA in patients undergoing endoscopy and should be made a routine practice.

Article InfoFootnotes

Conflicts of interest The authors disclose no conflicts.

Identification

DOI: https://doi.org/10.1053/j.gastro.2021.05.016

Copyright

© 2021 Published by Elsevier Inc.

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