Abstract
Purpose :
Patients who are intubated and sedated are at risk for developing exposure keratopathy, which can lead to permanent vision loss. The prophylactic application of lubricating ointments has been found to prevent exposure keratopathy in ICU patients. At our hospital system, an “Exposure Keratopathy Prevention Order Set” was implemented which automatically included lubricating ointment to both eyes every 6 hours for all mechanically ventilated patients. This retrospective chart review study analyzed the incidence of exposure keratopathy diagnosis before and after implementation of the Exposure Keratopathy Prevention Order Set.
Methods :
Patients who were on mechanical ventilation at the time of ophthalmology consult request between January 1, 2019, and December 31, 2021, were included. Ophthalmology consult notes of patients with keratopathy diagnosis were reviewed for details regarding the consult request, exam findings, diagnosis, and treatment plan. The data was analyzed using Fisher’s exact and Mann-Whitney U-tests to compare exam findings before and after the order set went live on June 2, 2021. A Fisher’s exact test was used to compare the rates of consults and positive exposure keratopathy diagnosis in 2021 before and after the order set was implemented.
Results :
There were a total of 247 and 361 ventilated ICU patients before and after the order set. The number of ophthalmology consults decreased slightly after the order set (Fig 1, blue bars. 6.1% and 5.5%). The rate of exposure keratopathy among ventilated patients decreased (Fig 1, red bars) from 4.5% (11/247 patients over 151 days) to 2.2% (8/361 patients over 212 days) (p=0.154) with a risk ratio of 0.50 (95% CI 0.20-1.22).
Conclusions :
The number of patients diagnosed with exposure keratopathy trended down after implementation of the Exposure Keratopathy Prevention Order Set. More data is needed to better elucidate the impact of this order set, but the trend seen in this study suggests this simple low-risk order set may have a meaningful impact on the number of patients with exposure keratopathy over an extended time period. We plan to conduct a larger study to further explore this issue.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.