Metodos de Protecao Ocular Durante A Anestesia Geral
Autor: Marcio Augusto Lacerda | Publicado: 2012-04-10T21:36:00-03:00

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&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Adaptado de Anaesthesia and Intensive Care 11:10



 

  
  




  
  


  
  


 

  
  


 




<!--[if !supportLists]-->1.&nbsp;&nbsp;&nbsp;&nbsp; <!--[endif]-->Fechamento manual das pálpebras



<!--[if !supportLists]-->a.&nbsp;&nbsp;&nbsp;&nbsp; <!--[endif]-->Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->evita
o trauma para o olho e pálpebras

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Evitar
ferimentos químicos associados a fitas, geleias e pomadas



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->inefetivo
em 59% dos pacientes por causa do lagoftalmos

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Nao
indicado para cirurgias na cabeça e pescoço e em pacientes na posição lateral e
em decubito ventral



2.&nbsp;&nbsp;&nbsp;&nbsp;Oclusao de palpebras com fita adesiva
(esparadrapo)



a.&nbsp;Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Protege
o olho da ceropatia por exposição, lesões químicas e traumas



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->oclusao
inadequadas resulta em ceropatia por exposicao

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->risco
de dermatite por reacao alergica a cola do adesivo

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Ha
sempre a possibilidade de se colocar a fita diretamente sobre a córnea

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Trauma
em cílios e pálpebras com remoção de fita





3.&nbsp;&nbsp;&nbsp;&nbsp;Oclusao somente da pálpebra superior com fita
adesiva (esparadrapo)



a.&nbsp;Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Protege
o olho da ceropatia por exposicao



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Não
protégé adequadamente o olho de lesão química ou trauma

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Nao
indicado para cirurgias na cabeça e pescoço e em pacientes na posição lateral
ou em decubito ventral

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->risco
de dermatite por reacao alergica a cola do adesivo







4.&nbsp;&nbsp;&nbsp;&nbsp;Oclusao com películas bio-oclusivas



a.&nbsp;Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Protege
o olho da ceropatia por exposição, lesões químicas e traumas



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->oclusao
inadequadas resulta em ceropatia por exposicao

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Possibilidade
de colocar a pelicula bio-oclusiva diretamente sobre a córnea

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Trauma
em cílios e pálpebras com remoção de fita

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->risco
de dermatite por reacao alergica a cola do adesivo









5.&nbsp;&nbsp;&nbsp;&nbsp;Pomada oftálmica



a.&nbsp;Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Igualmente
eficaz em prevenir abrasões da córnea como o fechamento de palpebras com fita
adesiva

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Permite
contínua monitorização do olho durante cirurgia nasolacrimal e endoscópica sinusal


<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Tempo
de retenção ocular longo 



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Varias
descricoes de lesões químicas aos olhos após o uso de pomadas contendo
conservantes como metilparaben e clorambutol:

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Provoca
“visão borrada em” 55 a 75% dos pacientes

<!--[if !supportLists]-->o&nbsp;&nbsp; <!--[endif]-->Provoca sensação de corpo estranho em 25 e
62% dos pacientes

<!--[if !supportLists]-->o&nbsp;&nbsp; <!--[endif]-->Risco de conjutivite por reacao alergica a
componentes da pomada

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Risco
de contaminacao pela pratica da reutilizacao

<!--[if !supportLists]-->o&nbsp;&nbsp; <!--[endif]-->Deve-se evitar ocluir palpebras





6.&nbsp;&nbsp;&nbsp;&nbsp;Metilcelulose e hidrogels



a.&nbsp;Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp; <!--[endif]-->Igualmente eficaz em prevenir abrasões da
córnea como o fechamento de palpebras com fita adesiva 

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Aumentar
a estabilidade do filme lacrimal



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Tempo
de retenção ocular relativamente curto 

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Provoca
uma sensação de corpo estranho em 2 a 3% dos pacientes

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Provoca
“visão borrada em” 55 a 75% dos pacientes

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Risco
de contaminacao pela pratica da reutilizacao







7.&nbsp;&nbsp;&nbsp;&nbsp;Curativo de hidrogel



r.&nbsp;Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp; <!--[endif]-->Permite contínua monitorização do olho
durante cirurgia nasolacrimal e endoscópica sinusal



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Não
tão eficaz como as pomadas oftalmicas e hidrogel na prevenção de abrasões da
córnea

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Os
curativos de hidrogel podem aderir aos tecidos adjacentes se secarem





8.&nbsp;&nbsp;&nbsp;&nbsp;Tampões oculares, com ou sem protetores
plasticos



a.&nbsp;Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Reduz
o risco de ferimento mecânico



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Devem
sempre ser usados em associacao a fitas adesivas de oclusao das palpebras e/ou instilação
local de gel 





9.&nbsp;&nbsp;&nbsp;&nbsp;Lentes de contato hidrofílicas



r.&nbsp;Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Igualmente
eficaz na prevenção de abrasao corneal comparando-se as pomadas/hidrogel e
oclusao palpebral com fitas adesivas 

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Aumenta
a estabilidade do filme lacrimal



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Risco
de trauma na inserção e remoção da lente

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Risco
de contaminacao se nao for adequadamente esterilizada e/ou manipulada





10.&nbsp;Tarsorrafia



a.&nbsp;Vantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Protege
o olho da ceropatia por exposição, lesões químicas e traumas

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Indicada
como protecao ocular em cirurgias de cabeça e pescoço e que utilizem a posicao
lateral ou decubito dorsal



b.&nbsp;Desvantagens

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Alta
incidencia de trauma (especialmente hematoma) de palpebra

<!--[if !supportLists]-->o&nbsp;&nbsp;
<!--[endif]-->Limita
a proptose compensatoria do globo ocular secundaria ao edema periorbital







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