Year 2021
October 2021


Abstract Title
Universal site marking protocol before ophthalmic regional block - an international survey



Khoo Teck Puat Hospital1

Background & Hypothesis

Wrong-site eye surgery has generated extensive attention, but wrong-site eye injection is under reported. The incidence of wrong-site eye injection is reported between 0.52 to 5.07 per 10,000 blocks. Several factors may contribute to wrong site injection; lack of site-mark visibility, time pressure and human factors.

World Health Organization, Joint Commission International and other major organizations produced a universal protocol “Performance of Correct Procedure at Correct Body Site” which recommend the proceduralist to confirm site of surgery with the patient and the use of preoperative marking with an indelible marker at or near the incision site which remain visible until the operative area has been prepped and draped. Despite the availability of the universal protocol, the incidence of wrong procedure has not decreased.


A WhatsApp message was sent to known international ophthalmic anaesthetists who attended the 4th World Congress of Ophthalmic Anaesthesia (2020) to evaluate international practices regarding eye site marking in their respective countries.


This survey involving participants from 10 countries and 17 hospitals revealed no universal method for eye site marking despite strong recommendations universal protocol. Most respondents use site marking with indelible marker above the eye. Surprisingly, several units also used additional methods to reinforce correct site marking to prevent wrong injection.

Discussion & Conclusion

Although a wrong injection may cause little or no permanent injury to the patient, but attempts should be made to prevent wrong-site injection by adhering to universal site-marking protocol recommendation advocated by WHO. Reporting of adverse events should continue until wrong site injection is eliminated.