Abstract
Purpose: :
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.
Methods: :
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.
Results: :
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].
Conclusions: :
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.
Keywords: cornea: clinical science • cornea: epithelium • cornea: tears/tear film/dry eye