Exposure keratopathy in sedated and ventilated patients

Jammal, Hisham M.; Khader, Yousef; Shihadeh, Wisam; Ababneh, Laila T.; AlJizawi, Ghazal; AlQasem, Arqam

doi:10.1016/j.jcrc.2012.02.005

Cited by 49 publications

(55 citation statements)

References 24 publications

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“…Although the reported incidence of EK varies, some studies have estimated the rates to be as high as 57% in mechanically ventilated ICU patients who do not receive proper prophylactic eye care [3]. These clinical studies have also shown that up to 75% of patients with EK will show signs of lagophthalmos and chemosis before developing the condition [16].…”

Section: Epidemiology Of Exposure Keratopathymentioning

confidence: 99%

“…Nonetheless, a 2003 survey found that despite the above findings, 75% of British ICUs were using Geliperm [42]. If artificial tears are unavailable, the use of punctal plugs in the lacrimal ducts may be used [3]. Further lubrication with ointment up to four times daily is also recommended [3].…”

Section: Treatmentmentioning

confidence: 99%

“…If artificial tears are unavailable, the use of punctal plugs in the lacrimal ducts may be used [3]. Further lubrication with ointment up to four times daily is also recommended [3]. Strict adherence to these steps allows for the eye to re-establish its homeostatic moisture levels and promote healing of the erosions.…”

Section: Treatmentmentioning

confidence: 99%

“…As superficial keratopathy worsens, the corneal epithelium becomes more permeable [45,46]. Of note, superficial keratopathy has been found in as many as 60% of intubated and sedated ICU patients [3,28]. Moving further along the continuum of acuity, eyelid swelling, conjunctival swelling with hyperemia, and eyelid crusting or discharge are the primary signs of infection in an ICU patient [3,37,47,48].…”

Section: Complications Of Exposure Keratopathymentioning

confidence: 99%

“…While management priorities of the critically ill patient must emphasize life-threatening problems, other issues with less immediate consequences may go unnoticed. Exposure keratopathy (EK), noted to occur in 37-57% of sedated or intubated ICU patients, is one of those "silent" morbidities [3][4][5][6]. Visual impairment or loss of vision due to EK, especially when secondary complications such as corneal infection are present, is a serious problem that can arise if proper precautions are not observed, and has the potential to cause long-term disability [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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Exposure keratopathy (EK) is a frequently overlooked complication seen in nearly 60% of sedated or intubated intensive care unit (ICU) patients. Signs and symptoms of EK often start as mild subjective complaints of eye pain and irritation, but can progress to vision loss in the most severe cases. For many critically ill patients, the presence of sedation effectively precludes their ability to communicate clinical complaints typically associated with EK. This, combined with the potentially severe sequelae, makes EK a potentially preventable complication and a patient safety issue. Clinical management of EK can be challenging for both providers and patients due to the nature of treatment with eye drops and ointments as well as the burden and expense of associated procedural interventions. Risk factors for EK have been extensively described in the literature, and wider dissemination of this knowledge should facilitate education of physicians and nurses regarding EK prevention. The most common risk factors include lagophthalmos, chemosis, Bell's palsy, and congenital deformities. Additionally, critically ill patients are less likely to be promptly diagnosed due to the focus of staff on life-threatening problems over ocular prophylaxis. However, the potential severity of complications associated with EK mandates that prevention remains a crucial component of the care of at-risk patients. The reader will explore the broad category of adverse medical occurrences included under the umbrella term, "errors of omission" (EOO): an error category that is most likely to culminate in EK. The most critical preventive measure is education of health care providers, although this may not be enough by itself. To this end, universal precautions against EK in combination with education may be used to help combat the relatively high incidence of this easily preventable ocular pathology.

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Section: Epidemiology Of Exposure Keratopathymentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Complications Of Exposure Keratopathymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

View full text Add to dashboard Cite

show abstract

Part I: Anesthesia and ventilator management in critical care patients

Patel¹,

Muir²

2021

J Am Coll Clin Pharm

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Prevalence and risk factors of exposure keratopathy among critically ill patients: A systematic review and meta‐analysis

Chen,

He,

et al. 2023

Nursing Open

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AimsTo identify the incidence, prevalence and risk factors of exposure keratopathy (EK) among critically ill patients.DesignSystematic review and meta‐analysis, in accordance with the PRISMA 2020 Statement.MethodsThe Cochrane Library, PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database (CBM), Weipu Database (VIP) and WanFang Database were systematically searched from inception to June 2022. Observational studies that reported EK among paediatric and adult critically ill patients were screened and included original articles based on the inclusion criteria. Two reviewers independently completed data extraction and quality assessments. Subgroup analysis investigated potential causes of heterogeneity.ResultsOf the 4508 studies identified, 23 studies involving 3519 subjects were included. The pooled prevalence of EK was 34.0%, and the pooled incidence rate of EK was 23.0%. Risk factors associated with EK in critically ill patients included lagophthalmos, chemosis, eye blinks <5 times per minute, mechanical ventilation, sedation, lower Glasgow Coma Scale (GCS) score and higher Acute Physiology and Chronic Health Evaluation (APACHE) II score.ConclusionThis review shows that EK rates are high in critically ill patients and are influenced by multiple factors. Medical staff should pay more attention to EK in critically ill patients, conduct professional evaluations and implement targeted eye care protocols to reduce its occurrence.Implications for PracticeThis study shows the frequency of and multiple risk factors for EK in critically ill patients, which provides evidence‐based guidance for nurses to evaluate the risk of EK in critically ill patients and take appropriate precautions to reduce the risk.Protocol RegistrationThe protocol was registered in PROSPERO (https://www.crd.york.ac.uk/prospero/) (CRD42022346964).Patient or Public ContributionNo patient or public contribution.

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Exposure keratopathy in sedated and ventilated patients

Cited by 49 publications

References 24 publications

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Part I: Anesthesia and ventilator management in critical care patients

Prevalence and risk factors of exposure keratopathy among critically ill patients: A systematic review and meta‐analysis

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