Prevention and treatment of exposure keratopathy in intensive care unit patients. A literature review

Prevención y manejo de queratopatía por exposición en pacientes de cuidado intensivo. Revisión de la literatura

Objectives: We design an instrument based in the literature review for prevention, early identification and managment of exposure keratopathy inte ICU, that prevents ocular complications.
Materials and methods: An extended review of the literature was performed.
Results: A guideline was developed for prevention and management of exposure keratopathy in the ICU, with a simple algorithm that prevents ocular complications due to its early diagnosis and treatment. Discussion: It is important to perform regular screening of all patients with risk factors in the ICU. This guideline includes a simple evaluation tool for the daily care, including eyelid closure and condition of the eye surface using fluorescein and a cobalt blue lamp, which detects early signs of exposure keratopathy. This assessment helps to provide a treatment defined by an algorithm that responds to the degree of lagophthalmos, with the aim of reducing the morbidity and serious complications linked to this disease.

1. Kanski JJ, Bowling B. Synopsis of clinical ophthalmology, expert consult-online and print, 3: Synopsis of clinical ophthalmology. Elsevier Health Sciences; 2012.

2. Hernandez EV, Mannis MJ. Superficial keratopathy in intensive care unit patients. Am J Ophthalmol. 1997;124:212–6.

3. Mercieca F, Suresh P, Morton A, Tullo A. Ocular surface disease in intensive care unit patients. Eye. 1999;13:231–6.

4. Rosenberg JB, Eisen LA. Eye care in the intensive care unit: Narrative review and meta-analysis. Crit Care Med. 2008;36:3151–5.

5. Jammal H, Khader Y, Shihadeh W, Ababneh L, AlJizawi G, AlQasem A. Exposure keratopathy in sedated and ventilated patients. J Crit Care. 2012;27:537–41.

6. Shan H, Min D. Prevention of exposure keratopathy in intensive care unit. Int J Ophthalmol. 2010;3:346–8.

7. Katz J, Kaufman HE. Corneal exposure during sleep (nocturnal lagophthalmos). Arch Ophthalmol. 1977;95:449–53.

8. Imanaka H, Taenaka N, Nakamura J, Aoyama K, Hosotani H. Ocular surface disorders in the critically III. Anesth Analg. 1997;85:343–6.

9. McHugh J, Alexander P, Kalhoro A, Ionides A. Screening for ocular surface disease in the intensive care unit. Eye. 2007;22:1465–8.

10. Dawson D. Development of a new eye care guideline for critically ill patients. Intensive Crit Care Nurs. 2005;21: 119–22.

11. Werli-Alvarenga A, Ercole FF, Botoni FA, Oliveira JA, Chianca TC. Corneal injuries: Incidence and risk factors in the Intensive Care Unit. Rev Lat Am Enfermagem. 2011;19:1088–95.

12. Suresh P, Mercieca F, Morton A, Tullo AB. Eye care for the critically ill. Intensive Care Med. 2000;26:162–6.

13. Grixti A, Sadri M, Edgar J, Datta AV. Common ocular surface disorders in patients in intensive care units. Ocul Surf. 2012;10:26–42.

14. Marshall AP, Elliott R, Rolls K, Schacht S, Boyle M. Eyecare in the critically ill: Clinical practice guideline. Aust Crit Care. 2008;21:97–109.

15. Ezra D, Chan MY, Solebo L, Malik A, Crane E, Coombes A, et al. Randomised trial comparing ocular lubricants and polyacrylamide hydrogel dressings in the prevention of exposure keratopathy in the critically ill. Intensive Care Med. 2009;35:455–61.

16. Koroloff N, Boots R, Lipman J, Thomas P, Rickard C, Coyer F. A randomised controlled study of the efficacy of hypromellose and lacri-lube combination versus polyethylene/cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Intensive Care Med. 2004;30:1122–6.

17. Sivasankar S, Jasper S, Simon S, Jacob P, John G, Raju R. Eye care in ICU. 2006 January 1, 2006. 11-4. doi:10.4103/0972- 5229.24683.