Abstract
Purpose :
Patients in the Intensive Care Unit (ICU) are predisposed to ocular complications due to their critical illnesses and the ICU environment itself. Ophthalmologic assessments of ICU patients pose several technical challenges as patients are often not medically fit for transportation to the ophthalmology clinic. As some equipment is only available in the outpatient setting, bedside examinations are inherently limited. To get a better understanding of the ocular pathology encountered in the ICU, we performed a retrospective review of all ophthalmology consults for adult patients in the Cleveland Clinic Foundation (CCF) intensive care units over the course of one calendar year.
Methods :
This retrospective chart review evaluated all adult patients admitted to any of the CCF main campus intensive care units who received a consult order to the ophthalmology service between January 1st, 2021, to December 31st, 2021.
Results :
In 2021, there were 169 consult orders placed for 157 patients (78 males, 79 females). The patients ranged from 18.2 to 90.5 years old, with a mean age of 55.7. Fifty-seven (33.7%) patients were either intubated or on tracheotomy-ventilation support. Of the consults placed, 145 required a bedside eye examination. The most common reasons for consultation were fungemia (n=45; 26.9%), blurry vision/vision loss (n=40; 23.7%), red eye (n=7; 4.1%), concern for corneal abrasion (n=6; 3.6%), eye pain, Kayser-Fleischer ring evaluation (n=5 each; 3.0%), papilledema evaluation, and floaters (n=4 each; 2.4%). The most common final diagnoses were fungemia without endophthalmitis and exposure keratopathy/dry eye.
Conclusions :
Ophthalmologic consultations are often requested for patients in the intensive care unit. The nature and severity of systemic diseases encountered in the ICU population are different from that typically encountered in the outpatient setting. Additionally, due to the severity of their morbidities, patients in the ICU may not be able to describe their subjective visual complaints or participate in portions of the examination, which can further limit bedside exams. This information can be useful for planning and managing consultation services and informing residency training programs.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.