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Jesse McCann, Irina Belinsky, Lisa Park; Prevention, Prophylaxis, and Treatment of Ocular Surface Disease in a Tertiary Care Inpatient Setting: Identifying Patients at Risk. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5434.
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The development of exposure keratopathy and bacterial keratitis in the inpatient population can be reduced through prevention. Interdisciplinary care approaches and order sets can be established for ocular protection once risk factors and treatment trends are analyzed.
A retrospective review of the medical records from inpatient ophthalmology consults at a large tertiary-care teaching hospital was performed from a period of March 2011 to September 2012. 41 patients were identified who met the criteria for inclusion in this study. Risk factors including neurologic status, sedation/intubation, lagophthalmos, exposure, inflammation, oncologic status, and infection were identified. The severity of the ocular surface disease was graded on a six-point scale. The patients’ pre-consult eye care regimen and post-consult eye care regimen were analyzed.
A total of 60 eyes from 41 patients consulted as inpatients for ocular surface disease were studied. The average patient age was 49. Of the patients who were able to perform visual acuity testing, best-corrected visual acuity in the affected eye was 20/32 at the time of the initial consult. Risk factors for corneal injury in the inpatient population included prior neurologic deficit (present in 73.17% of patients), 65.85% had anatomical factors affecting lid closure. 46.34% of patients had been intubated or in an intensive care unit during their admission. Of the cases examined, 36.85% had pre-consult corneal care regimens. Mean grading of ocular surface disease was 3.12 ± 1.83, ranging from trace punctate epithelial erosions and/or chemosis (Grade 1) to macro-epithelial defect (Grade 3) and bacterial keratitis (Grade 6). After ophthalmic evaluation, 82.93% of patients were prescribed artificial tears, 68.29% were prescribed ocular ointment, and 36.59% were prescribed topical antibiotics. Eyelid taping was advised in 9.76% of the cases studied.
By establishing risk factors for ocular surface injury checklists and prophylaxis programs can be established. Routine prescriptions for ocular protection, including eyelid taping and the use of ocular lubricants, can help reduce the burden of ocular surface injury in the inpatient population.
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