Why Black Eyes?

[nurseaboveboard]

Hello nurses. Recently a patient returned from the OR with black eyes following a procedure no where near the face. Don't want to give too much detail here you understand. Most of the bruising/bleeding was on the upper eyelids, and also bleeding ran under the skin alongside the nose, puffing out like a little bag of blood/hematoma. This was a complete surprise to the patient/floor nurses/docs. PT/PTT WNL. No HX bleeding disorders. Nobody was able to give a plausible reason. What if any thoughts can you offer re this. Perplexing.

[loricatus]

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?

[ayla2004, ASN, RN]

The procedure was simple mastectomy w/reconstruction, so I can't imagine that positioning had much to do with it? What exactly is done with the eyes in OR? Also, could it be from excessive gag/coughing reflex in recovery, trying to cough out the ET tube? Thanks everyone.

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,

[nurseaboveboard]

Thanks for your replies. PT had immed reconstruction with implant using just skin flaps from own breast. I don't see a need for PT to be prone for this type, but maybe you can enlighten me? I haven't observed in OR since my student days. Also, is there anything else that can substitute for taping the eyes, if that's the cause?

[maeyken]

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...

[nurseaboveboard]

Generally, which kind of tape is applied, who applies it and removes it, and at what point does the ET tube come out? Can someone describe for me? Thanks posters.

[maeyken]

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!

[nurseaboveboard]

Oh my, thank you so much. I'm probably thinking too much pressure when tape applied and/or came off of thin and/or delicate skin. You know, horse hooves...NOT zebras! When I typed in periorbital bleeding with anesthesia, amyloidosis came up. That would be the Zebra! The doctors (plastics and general surgeon) seemed clueless as to what happened, so hopefully, if something was accidently dropped on her face, they would own up to it, rather than leave someone wondering? Also, doesn't the PT have to start gagging before the tube comes out, and do they cough the tube out then, or is it pulled out at that point?

[maeyken]

Also, doesn't the PT have to start gagging before the tube comes out, and do they cough the tube out then, or is it pulled out at that point?

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.)

[beanal]

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.

[nurseaboveboard]

Good grief, I just caught this latest post. Terrible! I guess the mystery of the black eyes in this case will remain a mystery.

[Future O.R. Nurse]

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.

[muffin7]

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.