Effectiveness of Nursing Interventions to Prevent Dry Eye in Critically Ill Patients

Abstract

Background Critically ill patients are susceptible to the development of dry eye. Few studies have been conducted on how to best prevent and treat this condition. Objective To compare the effectiveness of 2 nursing interventions in preventing dry eye in adult intensive care unit patients: liquid artificial tears (Lacribell; Latinofarma) and artificial tears gel (Vidisic Gel; Bausch and Lomb). Methods In this randomized controlled trial, 140 participants were randomly assigned to 1 of 2 treatment groups: a liquid artificial tears group (n = 70) and an artificial tears gel group (n = 70). The study inclusion criteria were as follows: admission to the intensive care unit, age of 18 years or older, no diagnosis of dry eye at admission, receipt of mechanical ventilation, blink rate of less than 5 times per minute, and a score of 7 or less on the Glasgow Coma Scale. On 5 consecutive days, a single researcher who was unaware of the treatment assignment assessed the participants’ eyes using the fluorescein eye stain test and the Schirmer test for dry eye. Results Dry eye developed in 21% of participants who received liquid artificial tears versus 9% of participants who received artificial tears gel (P = .04). Conclusions In this study, artificial tears gel was superior to liquid artificial tears in preventing the development of dry eye. These results may help nurses deliver evidence-based eye care aimed at reducing the risk of dry eye in critically ill patients.

Causal validation of the risk for corneal injury in critically ill adults

“…Liquid artificial tears evaporate more easily and need to be instilled more frequently than ocular gel. 17 The significant incidence of corneal injury, 16.3%, was similar to cohort studies conducted in India and the United Kingdom, with incidences of 13.2% and 21.0%, respectively. 27,30 However, this incidence was lower than that found in the United States (38.5%) 3 and 3.5 times lower than the results of a study conducted in Minas Gerais, Brazil (59.4%).…”

“…17,18 Inter-rater agreement is an important validation step used for the calibration of the professionals for subsequent evaluations or analyses. 17 After completion of the pilot test, with a satisfactory agreement and the training period, the researchers started the study. The patients' corneas were evaluated on the first, third, fifth, seventh and 10th days of hospitalization.…”

Nursing care to COVID-19 patients on hemodialysis and in prone position: an experience report

“…Nursing care had to be readjusted, discussed with the team, planned, and registered based on manuals and guidelines directed at COVID-19 patients on hemodialysis and in prone position; this is henceforth described (7,(9)(10)(11)(12)(13)(14) .…”

“…Pupil assessment was hindered by prone position and it was common to find swollen eyelids, partially open and dry cornea, leading to a risk of corneal injury. The recommendations are prophylaxis for facial pressure injury, cornea hydration with eye drops or eye gel and closure of the patient's eyelids, aiming at corneal injury prevention (9)(10)(11)(12)(13) .…”

“…It should be emphasized that prone position is not free of complications, and Nursing care includes: verifying the existence of the necessary devices during emergency support with long lines for the mechanical ventilator; caution with the orotracheal tube in order not to injure the mouth; eye care through cornea hydration and eyelid occlusion to prevent corneal lesion; preventing pressure lesion through protection of bony protuberances in previously unused sites, such as face, thorax, knees, and hip; inspection and change of dressing of the catheter to avoid infection and catheter loss. These challenges daily permeate the care provided by the Nephrology Nursing team to COVID-19 patients (9)(10)(11)(12)(13)27) .…”