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Gaytri Gupta Elera, Sean Donghyun Kim, Deepak Sambhara, Ingrid U Scott, Seth Pantanelli; Rates of Prophylactic Ocular Lubrication Administration and Exposure Keratopathy in Adult Patients Admitted to Intensive Care Units of an Academic Medical Center. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6492.
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© ARVO (1962-2015); The Authors (2016-present)
Exposure keratopathy (EK) predisposes patients to infection, scarring, and corneal perforation. Critically ill patients are predisposed to EK due to sedation and paralytics. Prophylactic ocular lubrication can reduce EK incidence; however, there are no agreed upon ocular lubrication standards across intensive care units (ICU).The purpose of this prospective, observational case series was to investigate the incidence and severity of EK in intubated and sedated patients, and examine practice patterns on prophylactic ocular lubrication use.
Intubated and sedated patients across all 4 adult ICUs at Penn State Hershey Medical Center, from February to October 2018, received baseline anterior segment exams within 24 hours of intubation, and was repeated daily by a single examiner for 72 hours, or until patient extubation or death. Ocular surface exams were conducted using fluorescein strips and scored using three validated grading systems.
77 patients were identified; however, only 30 were included in the study and received formal ophthalmologic evaluation. Reasons for exclusion included inadequate sedation, extubation/expiration prior to first examination, or conversion to comfort care. Six patients (20%) were found to have corneal epithelial defects leading to an ophthalmology consult for further management. Of these 6 patients, 3 (50%) expired within 72 hours of admission, and one (16%) developed a corneal infiltrate requiring antibiotic therapy. No patients had orders to receive ocular lubrication at the time of intubation, and only one patient had orders to receive ocular lubrication on the third day of intubation. Between baseline exam to exam #3, Oxford scores increased from 2.46 to 3.15 (p = 0.32), National Eye Institute (NEI) corneal scores increased from 2.5 to 4.6 (p = 0.10), NEI conjunctival scores increased from 1.31 to 2.56 (p = 0.08) and Von Bijsterveld scores increased from 1.69 to 2.06 (p = 0.15).
Evidence of ocular surface disease, which may represent EK, is observed as early as day zero of hospitalization in intubated and sedated patients. Ocular lubrication prophylaxis remains underutilized across ICUs in this academic center. Further investigation is warranted to determine the effectiveness of prophylactic ocular lubrication to decrease the incidence and severity of EK.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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