Clinical PracticeCommon Ocular Surface Disorders in Patients in Intensive Care Units
Introduction
Patients in the intensive care unit (ICU) often have impaired ocular protective mechanisms as a result of metabolic derangements, multiple organ dysfunction, mechanical ventilation, and decreased level of consciousness. Such patients are at increased risk of ocular surface disorders, which, if not resolved, can result in serious visual impairment.1, 2 Moreover, in the ICU setting, the medical staff is primarily concerned with stabilization of vital bodily functions, including the cardiovascular, respiratory, and neurological status. Sedated ICU patients are incapable of protecting their eyes and may be unable to convey ophthalmological complaints. Because ICU staff members may lack awareness of the risk of injury and fail to perform regular ocular screening, ophthalmological disorders may go unrecognized.2, 3, 4
Section snippets
Method of Literature Search
A literature search was performed, using the keywords Intensive Care, Eye care, ICU, ITU, Ophthalmological disorders, Eye disorders. The search engines of CINAHL, PUBMED, EMBASE and COCHRANE library were all used in the initial search. A manual search was also performed on the reference lists of all papers relevant to the topic.
A total of 714 hits were provided through the search engines. The abstracts of these papers were reviewed by the first and second authors separately, and 165 papers were
Physiological Mechanisms of Eye Protection
In a healthy individual, the eyelids offer a mechanical barrier to the eye against trauma, desiccation, and adherence of microorganisms.5, 6, 7, 8 The blink reflex is necessary for adequate distribution of the tear film over the ocular surface.1, 2, 9 Muscle tonus of the eyelids during sleep is the exact converse of that found during waking. There is a tonic muscular activity in the orbicularis oculi muscle with a concomitant inhibition of tonus of levator palpebrae superioris.10 The lipid
Prevalence
Breakdown of the innate physiological eye protective mechanisms will predispose to ocular surface damage.27 Exposure keratopathy has been reported to occur in 3.6% to 60% of ICU patients, with a peak incidence between 2 and 7 days from admission.14, 28 The major studies on the prevalence and predisposing factors for ocular surface disorders in ICUs are summarized in Table 1.2, 6, 15, 28, 29, 30 A prospective audit designed by Dawson identified a similar rate of ocular surface disease in 37.5%
Conclusion
A review of the current literature shows a significantly high prevalence of ocular surface disease in the ICU setting. Furthermore, considerable variability exists in eye-care management among different ICUs. A number of studies established moisture chambers or polyethylene covers to be more effective than conventional treatments for preventing corneal desiccation and exposure keratopathy. Such methods may be particularly useful in patients with chemosis and lagophthalmos. They may also serve
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