Effect of polyethylene cover on the treatment of exposure keratopathy in ICU

Abstract

Background: Exposure keratopathy may lead to serious complications such as microbial keratitis, corneal perforation, and visual impairment if not treated.Aim: To compare the effect of carbomer eye drops when used alone and in combination with polyethylene covers in the healing of exposure keratopathy.Methods: A single blind randomized-controlled trial (RCT) in two intensive care units (ICUs) was carried out in a university hospital in Western Turkey between September 2011 and December 2012. The control group received only carbomer, eye drops while the intervention group received both carbomer eye drops and polyethylene covers. The primary outcome was the decrease or absence of corneal damage, which refers to healing. Corneal damage was followed up with a fluorescein dye test (decrease/absence of the corneal staining) by the same ophthalmologist for 10 days.Results: A total of 43 corneas in 24 patients were studied. Corneal epithelial defects decreased in the intervention group by day 2 and progressed or remained unchanged in the control group every day (P = .001). Patient characteristics did not affect the grade ranges of corneal staining in the groups except for level of consciousness. Conclusion:Carbomer eye drops, when used in combination with polyethylene covers, were effective in managing exposure keratopathy.Relevance to clinical practice: Corneal damage and further ocular complications can be reduced with the utilization of polyethylene covers in nursing care and treatment.

Effect of Polyethylene Cover for Preventing Corneal Injury in Critically Ill Patients: A Meta-Analysis

“…There are many risk factors to weaken the mechanism of eye protection in coma patients in ICU, which are prone to eye diseases [28,29]. The routine eye care plan is to use eye drops in the daytime and eye ointment to close the eyelids at night, but the effect of clinical intervention is not ideal [30,31]. Figure 5: Forest plot: comparison of incidence of corneal injury between polyethylene cover group and eye gel group.…”

“…The results showed that the polyethylene cover group was more effective than the control group in reducing the risk of occurrence of corneal injury [16]. In one randomized controlled trial by Kocaçal et al [30], the control group received only carbomer eye drops while the intervention group received both carbomer eye drops and polyethylene covers; the authors found that carbomer eye drops, when used in combination with polyethylene covers, were effective in managing exposure keratopathy.…”

Ocular care for unconscious patient in ICU

“…Carbomer, an acrylic acid polymers eye drops, when used in combination with polyethylene covers, were effective in managing exposure keratopathy. 3,[19][20][21][22][23][24] Surgical treatment: Surgical options as of punctal plugs, tarsorrhaphy, eyelid reconstruction, Gold or platinum weight implant, orbital decompression, conjunctival flap, amniotic membrane graft, even corneal transplantation may require according to need. If adequate corneal protection cannot be achieved with a combination of taping and lubrication temporary suturing of the lids may be the good option.…”

The effect of polyethylene cover intervention on ocular surface disorder of intensive care unit patients: a systematic review and meta-analysis

“…Unfortunately, healthcare professionals in different countries use different criteria when selecting eye care interventions in ICUs [ 3 , 8 ]. Various studies have warned that eye care regimens are not always safe and there is no adequate evidence for the best eye care interventions [ 9 , 16 , 17 ].…”