Highlights of Ophthalmology

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Related articles

VOLUME 50 , ISSUE 2ENG ( April, 2022 ) > List of Articles

Corneal Abrasion due to Applanation Tonometry. Clinical Audit to Reduce the Incidence of Corneal Abrasions After Applanation Tonometry

Chaitali Patel, Samir Bhavsar, Sonal Sisodia

Keywords : Clinical audit, re-audit, Applanation tonometer, Corneal abrasion

Citation Information : Patel C, Bhavsar S, Sisodia S. Corneal Abrasion due to Applanation Tonometry. Clinical Audit to Reduce the Incidence of Corneal Abrasions After Applanation Tonometry. 2022; 50 (2ENG):27-32.

DOI: 10.5005/hoe-10101-50204

Published Online: 04-04-2022

Copyright Statement:  Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: To decrease the rate of corneal abrasions after measuring intraocular pressure (IOP) by applanation tonometry. Method: Intraocular pressure measurement is a routine procedure, mainly in patients above the age of 40 years, known patients of glaucoma and glaucoma suspects. In a teaching institute like ours, this procedure is commonly carried out by the second and third year residents, using a Goldman applanation tonometer. In our institute it had come to our notice that after this procedure, quite a few patients had complaints of pain and foreign body sensation, suspected to be due to the iatrogenically created corneal abrasions. Thus, to minimize the incidence of corneal abrasions, clinical audit was carried out. Audit was done on 50 patients (100) eyes. The data was analyzed using Microsoft excel. A sensitization of the residents was carried out, to improve the technique. After few months re-audit was done on another 39 patients (78 eyes). Result: Data compilation was done and analyzed. In audit, around 29% of patients reported with corneal abrasion against a set target of 0%, and the result significantly improved to 13% after the entire process of re-audit. Conclusion: Measurement of IOP by applanation tonometry can be a significant factor in the cause of corneal abrasion, especially when done by residents. This may cause patient discomfort as well as serious corneal complications, thus endangering vision. Clinical Significance: Audit provided a scope in the improvement of the procedure of Applanation Tonometry, thus leading to better patient safety and satisfaction.


PDF Share
  1. Gurney JC, Ansari E, Harle D, O'kane N, Sagar RV, Dunne MC. Application of Bayes’ to the prediction of referral decisions made by specialist optometrists in relation to chronic open angle glaucoma. Eye. 2018 Jun;32(6):1074-8.
  2. Velis G, Kavitha S, Zebardast N, Sengupta S, Venkatesh R. Comparison of the corrected intraocular pressure by tonopachy with that of Goldmann applanation tonometry in normal and glaucomatous patients. Indian journal of ophthalmology. 2020;68(4):620.
  3. Realini T, Weinreb RN, Hobbs G. Correlation of intraocular pressure measured with Goldmann and dynamic contour tonometry in normal and glaucomatous eyes. Journal of glaucoma. 2009;18(2):119.
  4. Kniestedt C, Stürmer J, Stamper RL. Clinical alert: damage to Goldmann applanation tonometer tips. Acta Ophthalmologica Scandinavica. 2005;83(1):129-30.
  5. Aziz K, Friedman DS. Tonometers—which one should I use? Eye. 2018 May;32(5):931-7.
  6. Rawlins M. Principles for best practice in clinical audit. Radcliffe publishing; 2002.
  7. Johnston G, Crombie IK, Alder EM, Davies HT, Millard A. Reviewing audit: barriers and facilitating factors for effective clinical audit. BMJ Quality & Safety. 2000 1;9(1):23-36.
  8. Grainger A. Clinical audit: shining a light on good practice. Nursing Management. 2010 23;17(4).
  9. Patel, D. (2016). Study of Optimal Perimetric Testing In Children (OPTIC) (Doctoral dissertation, UCL (University College London)).
  10. Stevens S, Gilbert C, Astbury N. How to measure intraocular pressure: applanation tonometry. Community Eye Health. 2007;20(64):74.
  11. Bourin, M. (2018). The Audit in the Clinical Trial.
  12. Esposito P, Dal Canton A. Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World journal of nephrology. 2014 6;3(4):249.
  13. Tonazzini A, Bedini L. Degradation identification and model parameter estimation in discontinuity-adaptive visual reconstruction. Advances in Imaging and Electron Physics. 2003 1;120:193-284.
  14. Varkey P, Reller MK, Resar RK. Basics of quality improvement in health care. In Mayo Clinic Proceedings 2007 1 (Vol. 82, No. 6, pp. 735-739). Elsevier.
  15. Stevens S, Gilbert C, Astbury N. How to measure intraocular pressure: applanation tonometry. Community eye health. 2007;20(64):74.
  16. Paton JY, Ranmal R, Dudley J, RCPCH Clinical Standards Committee. Clinical audit: still an important tool for improving healthcare. Archives of Disease in Childhood-Education and Practice. 2015 1;100(2):83-8.
  17. Blumenthal EZ. Aligning the Goldmann Tonometer Tip by Means of the “Precontact Whitish Rings”. Survey of ophthalmology. 1999 1;44(2):171-2.
  18. Gupta S, Gupta P, Sayegh R. Healing a persistent corneal epithelial defect. EyeNet Mag. 2014:33-5.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.