Why Black Eyes?

I heard of a patient going blind in one eye when a first assistant was using a Deaver for abdominal surgery retraction. The assistants elbow was resting on the eye of the patient for an extended period of time and the patient was briused and subsequently went blind. I have never heard of coons eyes from a case in the supine position though.

Bleeding from the eyes suggests that her cappilaries had some kind of pressure on them. Everyone knows that the capillaries are the smallest veins that branch off larger veins. Sometimes a small scratch on your arm can cause a bruise. Brusing is the same thing. Maybe she choked on the intubation tube for a little while. Choking can cause this and so can high blood pressure.

What did the anesthesiologist say? Were the eyes taped too tightly closed? The OR Nurse should have been doing her "checks" by going under the sterile drapes (where possible)to make sure the patient was in correct position (arms on arm boards, foley bag in proper place, etc) and the head placement is part of these "checks". The head is checked by going up by anesthesia and literally looking at the head/tube placement. Was the tubing from the ET wrapped around the patients head (sorry, I know that I am reaching but I can't believe that if something was on the patient's face that the nurse or anesthesia did not see it.
That would be a crucial part of the puzzle. I would be interested in knowing.

I'm wondering if the patient had been on any NSAIDS or ASA too close to the time of her surgery, or if some chemo/radiation treatments had made her skin, especially around the eyes, extremely sensitive and friable, very likely to bruise and or tear? Another possibility is that she has/had some type of either dermatologic or ophthalmologic issue that she forgot to mention to anyone.
Since she wasn't prone at any time during the case and she had symmetrical black eyes, it's hard for me to buy into the idea that the assistant's elbow ended up in the same place twice on each side.....
or that the padding from various prone equipment could have interfered with her.
Was she perhaps a redhead or extremely lightly complected? THAT sounds stereotypical, but if she had truly fair skin, that may have contributed to it.

Overall, very odd case.

That does not that sound stereotypical.

I woke up after undergoing surgery to remove my gallbladder with bilateral "black" eyes several years ago. The bruising was so severe, one might have thought I'd been punched in the face. It was determined that the taping done by the anesthesiologist to protect my eyes and then the subsequent removal of the tape was the reason for the bruising in that delicate area. I have since had surgery in the prone position for several hours and although woke up with puffy eyes, never before or since had bruising of this severity. I believe that is the answer to your question and that there is no mystery here concerning your patient's black eyes.

I can't remember exactly how it happened, it was a long time ago, but I saw a CRNA's hand slip off of a Laryngoscope during a difficult intubation and hit the patient on the nose. I've never saw it before or since. It was strange. I don't know if the patient had any bruising, but I could see how s/he would have.

Hi

Just thinking, during the procedure, pt patient may have been leaned on and no one realized it. I've seen patient's with lower extremity bruises from resident's holding retraction and using the body for leverage.