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Second Opinions > Cataract Surgery: Patch or no Patch?

Cataract Surgery: Patch or no Patch?

We patch our cataract surgery patients with a folded eye pad wet with sterile water, then a full eyepad, then a shield. But we've also seen outbreaks of corneal abrasions, which are very painful. Should cataract patients be patched, or should we just cover the eye with a shield?

Started by: Vicky Presley (Director, Surgical Services/Director of Nursing) at June 22, 2012 (6:40 pm)

Comments and Responses

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Patients that receive topical anesthesia, have an eyeshield with no patch. Any patient that receives a block, an eyepad and shield are placed on the operative eye.

Julie S. (Director, Surgical Services/Director of Nursing) at October 29, 2012 (3:31 pm)

Most of our patients get a light block. We tape the lid close and have them remove the tape in a few hours. The reason is to decrease the corneal abrasions. Patients either scratch the eye themselves or the lid not functioning properly yet leads to exposure.

G. Stancel (Administrator/Director/Manager/Owner/Exec. Officer) at October 26, 2012 (7:25 pm)

We do not patch our cataract patients except if they are blocked and then they are taped, patched, and sheilded for 4 hours. We were sending our catarct patients home with instructions to wear their glasses or thier shield for the first day and the shield every night for a week but many were confused and were wearing their sunglasses all day and night and to thier post-op appointment so we shield them before they leave with a clear plastic shield and tell them they can remove it when they wake up the following morning and then only wear it at night for the first week. We did not notice any increase in post-op complications when they were not required to wear the shield the first day, but the patients seemed to want to wear something to protect their eye so we just shield everybody now.

K. Saxon (Director, Surgical Services/Director of Nursing) at October 22, 2012 (3:47 pm)

No patch.

JoAnn N. (Director, Surgical Services/Director of Nursing) at August 14, 2012 (1:43 pm)

Our topical gtt patients are instructed to keep their eye closed for 30 minutes after surgery and they have the eye sheild place until they see the Dr the next day. After the Dr. appointment, they are to wear either the sheild or their glasses during the daytime at home. They are to put the sheild on when sleeping.
Our blocks have a small piece of tape placed on the eyelid, then the eyepatch taped on then the the sheild. The patient is instructed to remove the tape and the eyepatch after 4 hours and to re-apply the sheild until they see the Dr. the next day. They are to wear the sheild while sleeping but again may use either their glasses or the sheild during the daytime.
It is sometimes hard for the topical patients to remember to keep their eye closed for the 30 minutes. For this reason I asked our surgeon once if we could patch the eye and remove the patch in 30 minutes. His answer was no. He said he did not want the patient opening their eye with the patch in place or it could cause an abrasion. He said that the block patients are not able to open their eye so this is not an issue with them.

Thank you for asking these questions on the second opinion board. I always find it facinating to see what others are doing, and appreciate the willingness for everyone to share. I have copied some great ideas from my peers.

Ermel H. (Director, Surgical Services/Director of Nursing) at July 11, 2012 (5:20 pm) [last edited on July 11, 2012 (5:23 pm)]

Our topical gtt patients are instructed to keep their eye closed for 30 minutes after surgery and they have the eye sheild place until they see the Dr the next day. After the Dr. appointment, they are to wear either the sheild or their glasses during the daytime at home. They are to put the sheild on when sleeping.
Our blocks have a small piece of tape placed on the eyelid, then the eyepatch taped on then the the sheild. The patient is instructed to remove the tape and the eyepatch after 4 hours and to re-apply the sheild until they see the Dr. the next day. They are to wear the sheild while sleeping but again may use either their glasses or the sheild during the daytime.
It is sometimes hard for the topical patients to remember to keep their eye closed for the 30 minutes. For this reason I asked our surgeon once if we could patch the eye and remove the patch in 30 minutes. His answer was no. He said he did not want the patient opening their eye with the patch in place or it could cause an abrasion. He said that the block patients are not able to open their eye so this is not an issue with them.

Thank you for asking these questions on the second opinion board. I always find it facinating to see what others are doing, and appreciate the willingness for everyone to share. I have copied some great ideas from my peers.

Ermel H. (Director, Surgical Services/Director of Nursing) at July 11, 2012 (5:20 pm)

our cataract patients comes out surgery with eye patched and metal shield on top secured and they come back to the eye clinic the very next day early morning for the Doctor to check the eye postoperatively remove patch and they go home with just a clear plastic or metal shield.Patients do not start eye drops post. op. unless instructed by Doctor to do so.

Lorna Tamimi Rn(V.A. 5H staff Nurse OCL)

LORNA TAMIMI (Other) at July 11, 2012 (9:36 am)

We do not patch cataract patients. They are instructed to cover the operative eye with a eye shield at night for 1-3 days post-op, which is dependent on the surgeon performing the procedure.

D. Baker (Administrator/Director/Manager/Owner/Executive Officer) at July 5, 2012 (12:48 pm)

We only patch the patients that are blocked. Many of our Ophthalmologists do not use ointment and only 1 patch. One Ophthalmolgist has the patient remove the patch and start the eye gtts 4 hours after surgery.

Carol Pearson (Director, Surgical Services/Director of Nursing) at July 5, 2012 (9:24 am)

We patch only if they receive a block but are instructed to wear a clear patch over the eye at night while they sleep.

C. Wren (OR Manager/Supervisor) at July 2, 2012 (1:57 pm)

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