How to clean an eyeball to prevent infection in a patient with complete vision loss due to acute artery occlusion?

Ocular Hygiene Protocol for Patients with Complete Vision Loss Due to Acute Artery Occlusion

Daily ocular hygiene must be performed by an ophthalmologist or ophthalmically trained nurse to prevent infection in patients with complete vision loss due to acute artery occlusion. 1

Immediate Management Considerations

• Acute retinal artery occlusion is a medical emergency requiring immediate referral to a specialized stroke center for prompt assessment and possible intervention 1
• Patients with acute occlusion should undergo urgent evaluation for vascular risk factors and potential causes, including embolic sources, carotid occlusive disease, and giant cell arteritis 1, 2
• The risk of stroke is highest in the first 7 days after onset of retinal artery occlusion, making prompt diagnosis and management critical 1, 2

Ocular Hygiene Protocol

Daily Care Requirements

• Daily ophthalmological review is necessary during the acute illness 1
• Ocular hygiene must be carried out each day by an ophthalmologist or ophthalmically trained nurse 1
• Apply an ocular lubricant (e.g., nonpreserved hyaluronate or carmellose eye drops) every 2 hours through the acute illness 1

Infection Prevention Measures

• Administer a broad-spectrum topical antibiotic as prophylaxis (e.g., moxifloxacin drops four times daily) in the presence of corneal fluorescein staining or frank ulceration 1
• Application of topical corticosteroid drops (e.g., nonpreserved dexamethasone 0.1% twice daily) may reduce ocular surface damage and inflammation 1
• In unconscious patients, prevention of corneal exposure is essential 1
• Never rinse the eye with tap water or bottled water, as this increases infection risk 1

Cleaning Technique

• Use only sterile products that are commercially prepared specifically for ocular care 1
• Clean from the inner corner of the eye (near the nose) outward to avoid contamination 1
• Use separate sterile gauze or cotton for each eye to prevent cross-contamination 1
• Apply gentle pressure during cleaning to avoid trauma to the ocular surface 1

Special Considerations

For Patients with Giant Cell Arteritis (GCA)

• If GCA is suspected (especially in patients over 50), immediate treatment with high-dose corticosteroids is necessary 1, 2
• More frequent monitoring may be required as these patients have a higher risk of complications 2

For Patients with Neovascularization

• Monitor for development of iris or retinal neovascularization 1
• Panretinal photocoagulation treatment is recommended for patients who develop iris or retinal neovascularization 1, 2

Follow-up Care

• Regular follow-up examinations are essential to monitor for complications 1
• Patients with greater ischemia require closer and more frequent follow-up 1
• Long-term ocular surface care may be necessary as patients with complete vision loss often develop dry eye and exposure keratopathy 1

Common Pitfalls to Avoid

• Delaying referral to stroke centers - acute retinal artery occlusion should be treated as a medical emergency 1, 2
• Using non-sterile products for eye cleaning, which increases infection risk 1
• Neglecting daily ocular hygiene, which can lead to corneal complications and infection 1
• Failing to consider systemic causes like giant cell arteritis, which requires immediate systemic treatment 1, 2
• Overlooking the need for prophylactic antibiotics in cases with corneal epithelial defects 1

Remember that while preserving vision may not be possible in complete occlusion cases, preventing infection and maintaining ocular surface health remains critical for patient comfort and to prevent further complications.