Prevalence and Risk Factors of Exposure Keratopathy Across Different Intensive Care Units

Abstract

Purpose: To determine the prevalence and risk factors of exposure keratopathy (EK) across different intensive care units (ICU) at Columbia University Medical Center, including the Pediatric ICU (PICU), Medical ICU (MICU), and Neurologic ICU (NICU). Methods: In this prospective cohort study, 65 patients were examined daily during their admission in the PICU (27 patients), MICU (15 patients), and NICU (23 patients). Data on eyelid position, conjunctival and corneal changes, Bell's and blink reflexes, medications, Glasgow Coma Scale rating, and ventilation type were collected. Results: Overall EK percentages were as follows: PICU 19%, MICU 60%, and NICU 48%. The prevalence of EK was lowest in the PICU (P = 0.013). Factors associated with EK were lagophthalmos (P < 0.001), an absent Bell's reflex (P = 0.003), an absent blink reflex (P < 0.001), conjunctival injection (P < 0.001), a low Glasgow Coma Scale score (P < 0.001), intubation (P < 0.001), surgery before examination (P < 0.001), dialysis (P = 0.002), and administration of opioid (P < 0.001), sedative (P < 0.001), and neuromuscular blocking medications (P = 0.006). Conclusions: This is the first study to examine the rates and risk factors of EK across different ICU settings. The prevalence of EK was lowest in the PICU, which may partly be explained by the increased number of PICU patients receiving noninvasive ventilation and the absence of conjunctival chemosis.

Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

“…Non-specificity of the ocular manifestations is another concern in the meta-analysis. Due to morbidities such as severe pneumonia and intensive care admission, several patients may develop non-specific conditions such as dry eyes, pain, chemosis and redness [49][50][51]. These features may not be directly related to the underlying disease, and may be observed in severely ill subjects.…”

The effects of passive blinking on exposure keratopathy among patients in intensive care units

“…Hartford et al . [ 1 ] reported EK in 19%, 60%, and 48% of cases in the Pediatric Intensive Care Unit (PICU), Medical Intensive Care Unit (MICU), and Neonatal Intensive Care Unit (NICU), respectively. Another study reported that the prevalence of EK was 27.3%.…”

“…Exposure keratopathy (EK) is a common problem among unconscious patients in Intensive Care Units (ICUs). [ 1 ] As a clinical syndrome, EK is characterized by the incomplete closure of the eyelids and defective tear film which lead to corneal injury. [ 2 ] In clinical examination, EK is characterized by irregular tiny abrasions of the inferior half of the cornea.…”

Impacto de una intervención sanitaria en los cuidados oculares en pacientes de la unidad de cuidados intensivos pediátricos

“…La lesión corneal observada en el presente estudio fue menor a la reportada por Hartford J y cols que encontraron 19% de lesiones corneales por exposición en un grupo de 27 pacientes en la unidad de cuidados intensivos pediátricos. Esta diferencia puede deberse al azar considerando el escaso (9) número de pacientes pediátricos incluidos . La lesión corneal en las terapias muchas veces no es reconocida por lo que cada centro hospitalario que maneje pacientes críticos debe desarrollar sus protocolos para el cuidado ocular.…”