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Brian P. Lehpamer, Teddy Lyu, Karen Fernandez, Henry A. Futterman, Penny A. Asbell; Identification of Risk Factors for Development of Inpatient Exposure Keratitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):82.
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To identify risk factors for inpatient exposure keratitis. To determine the need for education of non-ophthalmologist inpatient healthcare providers about exposure keratitis, and use knowledge of risk factors to develop educational tools for providers.
We performed a retrospective chart review of inpatients 18 years or older with exposure keratitis at a major New York City teaching hospital. Patients included were seen by the ophthalmology consult service over the past 3 years and had exposure keratitis severe enough to require active treatment with lubrication, antibiotics, occlusive dressing, moisture chamber goggles, and/or tarsorrhaphy. Exclusion criteria were: acute post-operative corneal abrasion, dry eye syndrome without exposure, and exposure without keratitis.
61 patients were identified. Average age was 61, with an average length of stay (LOS) of 15 days and median LOS of 11 days prior to the consult. 9 patients had exposure-related corneal ulcers, 66% (6/9) of which were culture positive. Major risk factors were intubation (22/61, 30%), facial nerve palsy (10/61, 16%), isolated lagophthalmos (7/61, 11%), and cicatricial lid changes (5/61, 8%). Inpatient location was identifiable in 59 cases. A disproportionate number came from physical therapy & rehab floors (3 floors contributing 30%, or 18/59) and ICUs (5 units contributing 23%, or 14/59) versus general medical/surgical wards (>20 floors contributing 40%, or 24/59). Over the preceding 3 years, 39% (24/61) of cases developed during the 1st Quarter of the Academic Year (July to Sept), 34% (21/61) during Q2 (Oct to Dec), 15% (9/61) during Q3 (Jan to Mar), and 11% (7/61) during Q4 (Apr to June). There was a statistically significant reduction in cases developing in the 2nd Half of the Academic year (16/61, 24%) versus the 1st Half (45/61, 74%) [p=0.03, two-tailed T test].
Similar to decubitus ulcers, exposure keratitis is an avoidable complication that has not been uncommon in the inpatient setting. Serious sequelae such as central corneal opacification and perforation have a devastating impact on vision and quality of life, and add significantly to the cost of hospitalization. Having identified key risk factors, we are implementing a targeted educational program for inpatient healthcare providers caring for high risk patients.
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