Eye in ICU

Case: 32 years old male was admitted with COVID pneumonia which required intubation, sedation, neuro-muscular blockade (NMB), and pronation is now extubated but complaining of foreign body sensation in the right eye and photophobia. On clinical exam found to have some ciliary flush. Your next step? (select one)

A) observation

B) saline drops

C) ophthalmic antibiotics

D) urgent ophthalmology consult

Answer: D

One of the usually neglected portions is ophthalmic care in ICU, particularly in high-risk patients. Many patients who require (NMB) may not be able to close their eyes fully despite full sedation. Pronation also increases intra-ocular pressure. Ciliary flush is an emergent clinical consult as there may be underlying infectious keratitis, iritis, or angle-closure glaucoma. Other emergent ophthalmic consults are:

• Decrease visual acuity
• Photophobia 
• Severe foreign body sensation (patient can't keep an eye open)
• Corneal opacity 
• Fixed pupil 
• Severe headache with nausea
• Concern for hyperacute bacterial conjunctivitis 
• Concern for corneal abrasion

#opthalmology

References:

1. Cheung CA, Rogers-Martel M, Golas L, Chepurny A, Martel JB, Martel JR. Hospital-based ocular emergencies: epidemiology, treatment, and visual outcomes. Am J Emerg Med. 2014 Mar;32(3):221-4. doi: 10.1016/j.ajem.2013.11.015. Epub 2013 Nov 14. PMID: 24418441.

2. Gilani CJ, Yang A, Yonkers M, Boysen-Osborn M. Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician. West J Emerg Med. 2017 Apr;18(3):509-517. doi: 10.5811/westjem.2016.12.31798. Epub 2017 Mar 3. PMID: 28435504; PMCID: PMC5391903.