Why Black Eyes?

The one thing I thought of that I mentioned earlier, was that anesthesia usually tapes the eyes shut during the case. Just today we had a pt get a small hematoma in the corner of her eye from the tape coming off. (I'd never seen it before today, though.) So that could be a possibility.

I've never seen a patient get a black eye from the coughing, but there's always a first!

We had a patient with darkened eyes (not exactly black and as severe as you described) that didn't know she had an adhesive allergy (to the tape). The IV site where the tape was also became reddened & that's what led to testing her on various other sites with different tape. Was this a possibility for your patient?

with or without reconstruction?. in my hospital Reconstruction start being prone s that a skin flap can be taken from the back and then the patient is flipped to supine,

I've not seen another way to close the eyes, other than suturing them shut which is sometimes done when they're in the field but not being worked on (major H&N surgeries).

I suppose that if a patient had allergies to every kind of adhesive tape, you'd just have to put in some eye lube and be careful? I would imagine that's rather rare though...

Our anesthetists do the eye taping (or resident or clerk working with them), and they use the paper tape for eyes. Usually the same tape is used for the ET tube (unless pt has beard... then they use stickier tape or a tube holder). They also remove the tape. Tape comes off before the tube comes out.

The ET tube comes out at different times depending on the anesthetist, patient condition, etc. Usually comes out in the OR, occasionally in PACU. Sometimes patients cough a lot, others don't at all. Most cough a little bit, and not too hard. Smokers cough more than non-smokers. It also depends on your anesthetist- some have nicer emergences than others!

Another thought I had was that sometimes during surgery, with the drapes over the patient, surgeons can lose track of where the patient's face is. We usually draw a face on the drapes to remind us where the pt is so we don't set things on the face, etc. Might be possible that something was dropped on the patient's face? I'd think that would be pretty obvious though, and so would be noted in the OR record.

I hope you get to the bottom of it soon!

That varies from anesthetist to anesthetist. It is not mandatory that the patient gag on the tube before removal, although it is often the case. Tubes are always pulled out though- I haven't seen a patient cough one out on their own yet! (tubes are held in place by a balloon, and the balloon needs to be deflated before the tube comes out.)