Abstract
Purpose :
Sedated and mechanically ventilated patients admitted to the intensive care unit (ICU) are at high risk of developing ocular complications related to exposure keratopathy. Some studies and institutions have recommended that eye lubricants be automatically ordered for every ventilated patient. As there is no existing protocol for eye care in intubated and sedated patients at the Cleveland Clinic Foundation (CCF), we performed a retrospective study to evaluate the incidence of exposure keratopathy in intubated and sedated patients in the CCF ICU who received a consult to the ophthalmology service.
Methods :
This retrospective chart review evaluated patients admitted to one of the CCF intensive care units who received consults to the ophthalmology service between January 2021 and March 2022.
Results :
From January 2021 to March 2022, there were 59 ophthalmology consults to the ICU for intubated and sedated patients. Of these 59 patients, 22 patients (37.3%) were noted to have exposure-related findings on eye exam. 2 patients had corneal ulcers (epithelial defect + stromal infiltrate), 5 patients had epithelial defects without infiltrate, 12 patients had punctate epithelial erosions (ranging from trace to confluent), and 2 patients had documented epithelial irregularity. At the time of initial ophthalmologic exam, only 5 patients (8.5%) had an existing order for eye care: two for eye ointment as needed and three for artificial tears or ointment 2-4x/day. None of the eyes found to have corneal ulcers or epithelial defects had any eye care orders prior to a provider noticing signs of exposure keratopathy. Of the 5 eyes with epithelial defects, 3 had resolution of the defect at follow-up, and 2 did not have follow-up. The two eyes with corneal ulcers both had resolved epithelial defects at their final follow-up.
Conclusions :
We found that over a 16-month period, 22 intubated and sedated patients were noted to have signs of exposure keratopathy on eye exam. While prophylactic eye care may decrease the incidence of exposure keratopathy in this population, the benefit must be balanced with the costs of treatment as well as the increased treatment burden it would place on both patients and their caregivers. Based on the low morbidity of events in our study population, larger studies would be needed to determine the cost effectiveness of prophylactic treatment in this population.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.