Ocular surface disease in intensive care unit patients

Mercieca, Franco; Suresh, Palaniswamy; Morton, Anthony; Tullo, A B

doi:10.1038/eye.1999.57

Cited by 86 publications

(116 citation statements)

References 15 publications

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“…The use of pharmacologic-induced paralysis or heavy sedation may inhibit this important natural mechanism of eye protection [6]. Fluid imbalances, increased vascular permeability, and positive pressure ventilation (PPV) may increase conjunctival edema, leading to difficulties with eye closure [32].…”

Section: Exposure Keratopathy: Pathophysiology Diagnosis Symptoms mentioning

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%

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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: Exposure Keratopathy: Pathophysiology Diagnosis Symptoms mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

“…9 In the ICU there is a constant concern of the medical and nursing staff with the stabilization of the respiratory, cardiovascular and neurological status of the patients. 10 In this context, preventive measures and interventions to care for changes in the ocular surface of ICU patients are not given the due importance, despite its high incidence. [3][4][5][6][7][8]11 As most of the time the patients are unable to report ocular symptoms, often this problem is neglected.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7][8]11 As most of the time the patients are unable to report ocular symptoms, often this problem is neglected. 4,10,12 The tear film covers the frontal area of the eyeball, and the perfect integrity of the ocular surface is determined by the associated stability of the tear film and the epithelial layer of the cornea. The dysfunction of the lacrimal film, known as "dry eye" is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface.…”

Section: Introductionmentioning

confidence: 99%

“…4 The risk factors for dry eye, indicated by 50% or more of the analyzed studies were lagophthalmos (85.18%), 3,[5][6][7][8]16,[25][26][27][28][29][30][31] sedatives (70.37%), 1,[3][4][5][6]8,10,16,26,29,31,33, MV (66.66%), 1,[3][4][5][6][7][8]10,16,24,26,29,33, , and muscle relaxants (55.55%). 1,[3][4][5][6][7][8]10,27,29,31, Lagophthalmos is described as the incomplete or inadequate eyelid closure and is diagnosed when part of the conjunctiva or cornea is visible. …”

mentioning

confidence: 99%

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Dry eye in critically ill patients: integrative review Olho seco em pacientes críticos: revisão integrativa

Araújo

Ribeiro

Silva

et al. 2017

R. pesq. cuid. fundam. online

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Objetivo: Identificar na literatura publicações sobre os fatores de risco para o olho seco em pacientes internados em unidade de terapia intensiva de adultos. Método: Realizou-se busca nas bases de dados MedLine, CINAHL, Web of Knowledge, LILACS, Cochrane, IBECS e BDENF. Foram identificadas 620 publicações potencialmente elegíveis para inclusão nesta revisão, selecionando-se ao final vinte e sete publicações que atenderam aos critérios de inclusão. Essas foram analisadas por dois pesquisadores independentes, usando-se instrumento adaptado para verificar o nível de evidência. Resultado: Foram identificados 39 diferentes fatores de risco para olho seco, sendo que os apontados em 50% ou mais dos estudos, o lagoftalmo (85,18%), uso de sedativos (70,37%), ventilação mecânica (66.66%) e uso de bloqueadores musculares (55,55%). Conclusão: Foi encontrado somente um estudo que abordasse especificamente o problema do olho seco em pacientes críticos; estudos clínicos são necessários, a fim de se apresentar evidências científicas fortes ao problema.

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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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Ocular surface disease in intensive care unit patients

Cited by 86 publications

References 15 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

Dry eye in critically ill patients: integrative review Olho seco em pacientes críticos: revisão integrativa

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

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