Release for cornea donation post-autopsy is too late.
Time is our worst enemy. The national average between death and preservation of the cornea is 8 hours. While the eye bank can, on a case-by-case basis, extend that to 18 hours, most autopsies are not completed in that timeframe. At the Rocky Mountain Lions Eye Bank, the average death to preservation time on eye-only donations under the coroner with pre-autopsy release is 5.5 hours. The average death to preservation on eye and tissue/organ cases released pre-autopsy average 14.2 hours. The average death-to-preservation of non-coroner cases at RMLEB is 8.5 hours.
Drawing vitreous fluid BEFORE cornea recovery often destroys the endothelium because the eye collapses.
If you intend to allow the recovery of the corneas, please let the eye bank collect the vitreous fluid at the time of recovery.
The cornea is rarely useful in determining a cause or manner of death.
The National Association of Medical Examiners advocates release for cornea donation in all cases. We recommend you have a conversation with your pathologist to determine which cases a cornea would have bearing on determining a cause of death.
The eye bank's procedure does not destroy evidence.
The eye bank technician will look for and document petechiae, iris color, pupil sizes and abnormalities in the eye at the time of recovery. The eye bank technician will collect vitreous fluid as evidence, seal it in tamper-evident envelopes and leave it with the body (or deliver however you like). Tubes/lines or bandages are not moved or removed. If our technician thinks any of these items are in the way or is unable to establish a proper sterile field, he or she will call the administrator/supervisor on-call to discuss the options. Most likely, that would be to ask the coroner/investigator to conduct a visual inspection of the body to see if the obstruction could be moved prior to moving forward with the recovery. Eye tissue recovery could not occur with a helmet in place. Gross trauma to the corneas (ex. glass shard in the eye) would also prevent recovery from occurring.
Most things do not hinder recovery.
Dirt or other loose debris is not an immediate concern. The damage to the cornea is assessed once it is returned to the lab and evaluated under a powerful microscope. Broken orbital bones from trauma can often make the position of the eye odd but aren't typically a problem. In most cases, a noose would not hinder recovery. Each of these is assessed by the technician on the case, who would then consult the supervisor/administrator on-call and the coroner, if necessary. A request of the coroner to do a visual inspection prior to recovery may be necessary.
Recovering the eye tissue.
The eyes are rinsed with saline to remove any debris. The technician then uses isopropyl alcohol wipes to clean the area, including an inch above the brow to the upper eyelid line (including lashes) and the lower lid to an inch below the lower lid. That is followed by swabbing with povidone-iodine in concentric circles to that same dimension (about 2 inches in all directions from the center of the eye). The sterile field consists of a fenestrated drape where the hole is about 2" in diameter. It covers the brow ridge, and only the eye is visible. For prep of the eye, 10-15 drops of Betadine are placed in the eye for a period and then rinsed with sterile saline. After the recovery is complete, the technician will place eye caps and clean the area of the iodine with sterile saline-soaked gauze. Massage cream is used around the eyes to keep the lids from drying out, a complaint often heard from funeral homes. Coroners and staff are welcome to observe an eye tissue recovery.