How can surgeons protect the eyelids and surrounding skin during periocular skin prep?

• A. Use minimal antiseptic and barrier methods; avoid ocular contact; use sterile gauze to protect the eye.
• B. Use large quantities of antiseptic near eye.
• C. Ignore protective measures if patient is awake.
• D. Involve nonsterile assistant to hold eyelids open.

Answer: (A)

Protecting the eye and surrounding skin during periocular prep means keeping the eye safe from chemical exposure while still effectively disinfecting the surrounding area. The eye is highly sensitive to antiseptics, so use only a small amount of antiseptic near the eye and create a physical barrier to prevent any solution from reaching the ocular surface. A sterile protective barrier, such as a sterile gauze pad or an ocular shield, placed over the eye with the eyelids closed helps keep the prep solution away. In addition, a barrier around the lid margins, often with a petroleum-based product, can prevent seepage into the ocular area. If any antiseptic contacts the eye, irrigate promptly to dilute and remove it. This approach achieves disinfection of the periocular skin while minimizing risk to the eye.

Using large quantities of antiseptic near the eye increases the chance of irritation or chemical injury. Ignoring protective measures when the patient is awake is unsafe. Having a nonsterile assistant hold the eyelids introduces contamination and potential injury.